Nilce Emy Tomita

A saúde bucal do idoso brasileiro: revisão sistemática sobre o quadro epidemiológico e acesso aos serviços de saúde bucal

Population aging and declining birth rate have significantly altered the Brazilian age structure pyramid. In parallel with demographic transition, epidemiological transition is altering morbidity-mortality profiles, without adequate health support for the elderly population group. By searching databases, the objective of this study was a systemic literature review from 1986 to 2004 concerning the most prevalent oral problems experienced by elderly Brazilians, aimed at revealing the main obstacles for accessing health services. Mean DMFT index values in this study ranged from 25 to 31. Most articles reported a high percentage of edentulism. The main barriers for access to dental services were poor education, low income, and scarcity of public oral health services. Brazilian elderly oral health is thus precarious, with high edentulism rates, periodontal problems, decayed teeth, and great need for prostheses, reflecting the historical inefficacy of public dental services, limited to serial extractions and emergency services, based on the curative model.

Relação entre hábitos bucais e má oclusão em pré-escolares

OBJECTIVE To evaluate the way oral habits and speech problems affect dental occlusion in preschool children. METHODS A random sample of 2,139 boys and girls aged 3-5 years old was evaluated. The children were enrolled in private and state institutions in the city of Bauru, São Paulo State, Brazil. The cross-sectional study was developed in two steps: occlusion assessment, and a questionnaire about their social and economic status. The occlusal anatomical-functional characteristics assessment was done according to Angle classification. Additionally, overjet, overbite, crowding, anterior open bite, posterior crossbite, and anterior crossbite were evaluated. A sub-sample of 618 children filled out the questionnaire. The prevalence of malocclusion and some variables of exposure were tested by bivariate analysis. RESULTS The prevalence of malocclusion was 51.3% for boys and 56.9% for girls. There was no difference related to gender. In regard to age, there was a higher prevalence of malocclusion in the 3 year-old group, which decreased significantly with age (p<0.05). CONCLUSIONS Among the environmental factors evaluated, the habit of sucking a pacifier was the most important in the association with malocclusion (OR=5.46) followed by the habit of sucking fingers (OR=1.54). Speech problems did not show any influence in malocclusion occurrence.OBJETIVO: Avaliar como o desenvolvimento de habitos bucais deleterios e os problemas de fala afetam a oclusao dentaria em pre-escolares. METODOS: Foi constituida a amostra probabilistica por 2.139 criancas de ambos os sexos, na faixa etaria de 3 a 5 anos, matriculadas em instituicoes publicas ou privadas do Municipio de Bauru, SP, Brasil. Foi desenvolvido estudo transversal em duas etapas: exame de oclusao e questionario socioeconomico. A classificacao de Angle foi adotada para avaliacao de aspectos morfologicos da oclusao, observando-se tambem trespasse horizontal e vertical, espacamento/apinhamento, mordida aberta anterior, mordida cruzada total, mordida cruzada anterior e mordida cruzada posterior uni ou bilateral. Uma subamostra de 618 criancas apresentou resposta ao questionario sobre habitos bucais, saude infantil e informacoes sobre condicoes socioeconomicas. RESULTADOS: A prevalencia de ma oclusao foi de 51,3% para o sexo masculino e 56,9% para o sexo feminino, sem variacao quanto ao sexo. A maior prevalencia de ma oclusao foi verificada no grupo etario de tres anos, decrescendo significantemente com a idade (p<0,05). CONCLUSOES: Entre os fatores ambientais estudados, o habito de succao de chupeta foi o mais importante na associacao com ma oclusao (OR=5,46), seguido da succao digital (OR=1,54). Dificuldades na fala nao apresentaram relacao com a ma oclusao.

Programa de agentes comunitários de saúde: a percepção de usuários e trabalhadores da saúde

Two basic premises of Brazils Community Health Agents Program (PACS) are to value the family and community to which the program belongs and to encourage their participation in health promotion and disease prevention. This study focused on the work developed by PACS in Bauru, São Paulo State, as perceived by the community health agents and the families served by them. As the studys point of departure, 22 community health agents and 22 representatives of families were interviewed, randomly selected according to residential micro-areas. Two focus groups were formed according to the PACS to which the community agents and families belonged. Qualitative analysis of the answers demonstrated agreement between the perceptions by community health agents and the community in the two focus groups. However, the two focus groups differed from each other. Distinct realities were observed in the two communities, thereby orienting new program actions and handling of local difficulties.

Prevalência e características associadas à síndrome metabólica em nipo-brasileiros com e sem doença periodontal

This cross-sectional study focused on the relationship between periodontal disease and metabolic syndrome. Data were analyzed from 1,315 Japanese-Brazilians ranging from 30 to 92 years of age, submitted to physical, laboratory, and dental exams. Means and percentages were used in the data description and logistic regression pattern in the analysis of associations among variables. 484 (36.8%) of the 1,315 were edentulous, 215 (16.4%) enjoyed periodontal health, 513 (39%) had gingivitis, 85 (6.5%), showed initial or moderate periodontitis, and 18 (1.4%) suffered from chronic periodontitis. Prevalence of metabolic syndrome was 54.3%, higher among individuals with periodontitis than in the healthy (51.5% vs. 48.8%), but this association was not statistically significant. Individuals with metabolic syndrome showed a worse metabolic and anthropometric profile.

Prevalência de cárie dentária em crianças da faixa etária de 0 a 6 anos matriculadas em creches: importância de fatores socioeconômicos

Foi avaliada a prevalencia de carie na denticao decidua de criancas entre 0 e 6 anos, matriculadas em creches dos Municipios de Bauru e Sao Paulo, SP (Brasil). O primeiro grupo (Bauru) nao recebia cuidados sistematizados de saude na instituicao e o segundo (Sao Paulo) apresentava uma rotina de cuidados como norma institucional. Foram analisadas as variaveis relativas aos modos de viver desses grupos populacionais e sua associacao com a ocorrencia de carie, efetuando um estudo de caso para caracterizacao de fatores coletivos de risco a carie. Atraves de analise de regressao multipla, verificou-se a influencia da idade e frequencia de consultas odontologicas sobre a prevalencia de carie na amostra estudada (p<0,05). Na faixa etaria de 5-6 anos, 23,3% das criancas de Bauru e 9,3% de Sao Paulo estavam isentas de carie, contra a expectativa de 50% prevista na Meta n.o 1 da Organizacao Mundial da Saude para o ano 2000. A prevalencia de carie foi mais elevada em Bauru nas criancas de 3-4 e 5-6 anos, apresentando significância estatistica apenas para o grupo 3-4 anos (p<0,05). Nao foram observadas diferencas estatisticamente significantes entre os sexos quanto a ocorrencia de carie.Oral health condition in samples of children from zero to six years old, examined in day nurseries for children from Bauru and S. Paulo County (Brazil) by the caries indicator in primary dentition-dmfs, is assessed. The first group did not receive oral health care where any as the second group received the standard oral care provided by the institution. Variables related to way of life and their relationship to the presence of caries were evaluated. Multiple regression analysis showed a statistically significant association of age and frequency of dental visits with the prevalence of dental caries (p < 0.05). The data also showed that 23.3% of the children from Bauru, and 9.3% of those from S. Paulo were free of caries, numbers that are very far from the 50% proposed by WHO for the year 2000. The overall prevalence of dental caries was greater for the Bauru group than for the S. Paulo group; however, statistical significance was only found in the 3-4 age-group (p < 0.05). Sex differences in the occurrence of dental caries were not statistically significant.

Preferências por alimentos doces e cárie dentária em pré-escolares

OBJECTIVE To assess the preference for sweetness among preschool children and differences between less and more deprived groups. In addition, to assess whether sweet taste preference was associated with presence of caries. METHODS The sample was composed by 572 preschool children aged between 4 and 6, distributed in three day nurseries of varied socioeconomic background. Cross-sectional study developed in two steps. Preference for sweetness was assessed using a modified version of the Sweet Preference Inventory. The solutions varied in sugar concentration from 0 to 1,17 molar (0 to 400 g / litre). The presence of caries was assessed using the defs index. The socioeconomic status of the sample was classified according to the origin of domicile. RESULTS The variation in preference for sweetness in our sample was too small. Most children preferred the sweetest juice. This reduced the ability of this variable to explain variation in caries prevalence. Despite this limitation, our results showed that socioeconomic level influenced preference for sweetness, which in turn was associated with caries prevalence. CONCLUSION The socioeconomic status influence the sweetness preference and this, in turn, is associated with the dental caries prevalence.OBJETIVO: Avaliar as preferencias pelo sabor doce e sua associacao com as condicoes socioeconomicas e a prevalencia de carie dentaria em pre-escolares. METODOS: A amostra foi composta por 572 criancas de 4 a 6 anos, matriculadas em pre-escolas, dividida em estratos socioeconomicos segundo a procedencia (um bairro central, um periferico e Programa de Desfavelamento). Estudo transversal, foi desenvolvido em duas etapas. A preferencia pelo sabor doce foi avaliada atraves do Sweet Preference Inventory modificado. A concentracao das solucoes variou de 0 a 400 g/litro (0 a 1,17 molar). Foi utilizado o indice ceos para verificar a prevalencia de carie. RESULTADOS: Foram encontradas diferencas estatisticamente significantes entre as criancas do Programa de Desfavelamento e dos demais grupos na preferencia pelo sabor doce e no consumo de acucar, bem como associacao entre a procedencia e o percentual de criancas livres de carie, sendo o grupo do Desfavelamento o menos favorecido (p<0,05). CONCLUSAO: Os achados sustentam a hipotese de que o nivel socioeconomico influencia a preferencia por acucar e esta, por sua vez, esta associada a prevalencia de carie dentaria na denticao decidua.

Perda dentária e a imagem do cirurgião-dentista entre um grupo de idosos

This study assesses perceptions, memories and beliefs about tooth loss in a group of Japanese-Brazilian senior citizens, selecting forty individuals through a random sampling process, with inclusion criteria related to their background (Issei/Nissei) and oral status (edentulous/non-edentulous), divided into four groups, each with ten subjects. Home interviews were conducted with individuals complying with the inclusion/exclusion criteria established for each group. Using the construction of the Collective Subject Discourse as a methodological strategy, the analysis categories were defined: cause of tooth loss, time of tooth loss and the role of the dentist. Difficulties in accessing dental care and natural acceptance of tooth loss are social and cultural factors that are strongly associated with early edentulism. Pain and fear are the feelings related to the image of the dentist. However, the participants acknowledge that Dentistry has progressed, in terms of equipment, materials and techniques, as well as the training and conduct of dentists.

O risco espacial e fatores associados ao edentulismo em idosos em município do Sudeste do Brasil

This study aimed to identify factors associated with edentulism and spatial risk of tooth loss in the elderly. A cross-sectional study was conducted using a random sample (n = 372) of individuals 60 years and older in Botucatu, Sao Paulo State, Southeast Brazil, in 2005. Crude and adjusted prevalence ratios were estimated by Poisson regression with robust variance. Spatial analysis was performed using Kernel intensity estimation. Prevalence of edentulism was 63.17%. Socio-demographic factors associated with edentulism according to multiple regression were low schooling, household crowding, not owning a car, older age, lack of a regular dentist, and the last dental visit three previously or longer. Spatial analysis showed greater risk of edentulism in the peripheral areas of the city. The results help understand the high prevalence of tooth loss among the elderly, thus providing essential information for planning oral health interventions.

Condições periodontais e diabetes mellitus na população nipo-brasileira

OBJECTIVE To evaluate the relationship between diabetic status and periodontal conditions in the Japanese-Brazilian population. METHODS The sample consisted of 1,315 subjects, of both sexes, first (Issei) and second (Nisei) generations, aged 30 to 92 years, living in Bauru, Brazil. Edentulism and presence of 6 null sextants were the exclusion criteria for the sample. The Community Periodontal Index and Periodontal Attachment Loss Index were determined using the probing of 10 teeth in a sample of 831 subjects. The diagnosis of diabetes mellitus was based on fasting blood sugar and blood sugar 2 hours after 75 mg of glucose overload. Statistical analysis was conducted using Kappa test and Chi-square test. RESULTS Regarding periodontal conditions, 25.5% of the sample were healthy people, 12.5% showed bleeding on probing, 49.4% calculus, 10.4% pockets of 4-5 mm deep, and 2.2% pockets deeper than 6 mm. The percentage of subjects with an attachment loss of 0-3 mm was 24.2%; 4-5 mm, 36.7%; 6-8 mm, 23.7%; 9-11 mm, 11.3%; and up to 12 mm or more, 4.1%. The association between the periodontal condition and diabetes mellitus showed no statistical significance (p<0.05), although diabetic subjects have a higher percentage of deeper pockets and attachment loss >6 mm than non-diabetics, as tested by Chi-square test. CONCLUSIONS Epidemiological studies relating oral health and systemic disease, such as diabetes mellitus, can provide important contributions for preventing the worsening of such diseases.

A relação entre o espaço e a saúde bucal coletiva: por uma epidemiologia georreferenciada

The influence of the environment on health is an ancient human concern. From the Hippocratic texts to today, the concept of space permitted and still permits different representations and forms of perception. Overcoming the natural conception of space as only an inert and passive environment, the idea of a socially constructed geographic space, both as a receiver of social processes as much as being its own activator in these processes, becomes ever more relevant in the comprehension of phenomena involved in the health-disease process. In this sense, epidemiology is presented as a privileged reference point in the articulation of place-time-people elements. This reflexive investigation seeks to explore the relations established between space (social and geographical) and Collective Oral Health, emphasizing the role of territory in the reproduction of iniquities in health and the necessity of developing studies that approach space as a constitutive element in the oral health-disease process. In what could be termed a georeferenced epidemiology, the spatial expression of events of oral health-disease and of the actors involved in this process strengthens the importance of territory (and its various significations) to Collective Oral Health.