Nilcema Figueiredo

Aspectos metodológicos do Projeto SBBrasil 2010 de interesse para inquéritos nacionais de saúde

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the countrys five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).

Determinantes individuais e contextuais da cárie em crianças brasileiras de 12 anos em 2010

OBJECTIVE To estimate the prevalence and severity of dental caries in Brazilian children and the association with individual and contextual factors. METHODS Data were taken from the Brazilian Oral Health Survey (SBBrasil 2010) a sample of 7,247 12-year-olds. The data were collected using clinical examinations and interviews. The dependent variables were the prevalence of dental caries (decayed, missing and filled teeth [DMFT] ≥ 1 and DMFT ≥ 4). Bivariate (Rao Scott test) and multivariate (Poisson regression) analyses were carried out. The individual variables were sociodemographic variables, periodontal health and reporting discomfort while brushing. Contextual factors were the presence of water fluoridation, the percentage of residences connected to the water supply and median income of the municipality. RESULTS The prevalence of DMFT ≥ 1 was 56.0%. Mean DMFT was 2.04 (95%CI 1.76;2.31) and 22.2% of children had DMFT ≥ 4. Caries experience was significantly more common in children with black, brown or yellow skin; in low-income families; in children with dental calculus or bleeding gums and in those who reported discomfort while brushing. Living in towns with fluoridated tap water, with low coverage of water supply and with low median income were contextual factors associated with the disease. CONCLUSIONS The prevalence of dental caries in Brazilian 12-year-olds was low, according to World Health Organization criteria. There were significant geographical and socioeconomic inequalities in levels of the disease.OBJETIVO: Estimar a prevalencia e gravidade de carie em criancas brasileiras e sua associacao com fatores individuais e contextuais. METODOS: Foram utilizados os dados da Pesquisa Nacional de Saude Bucal (SBBrasil 2010), em uma amostra de 7.247 criancas de 12 anos. Os dados foram coletados por meio de exames clinicos e entrevistas. As variaveis dependentes foram as prevalencias de carie (dentes permanentes cariados, perdidos ou obturados [CPOD] ≥ 1 e CPOD ≥ 4). Foram realizadas analises bivariadas (teste de Rao-Scott) e multinivel (regressao de Poisson). As variaveis individuais foram sociodemograficas, condicao periodontal e relato de incomodo ao escovar os dentes. Os fatores contextuais foram a presenca de agua fluoretada, a porcentagem de domicilios ligados a rede de abastecimento de agua e a renda mediana do municipio. RESULTADOS: A prevalencia de CPOD ≥ 1 foi 56,0%. O CPOD medio foi igual a 2,04 (IC95% 1,76;2,31) e 22,2% das criancas tinham CPOD ≥ 4. A experiencia de carie foi significantemente mais elevada em criancas de cor de pele preta, parda e amarela; em familias com renda mais baixa; em criancas com calculo dentario ou sangramento gengival; e naquelas que relataram incomodo ao escovar. Viver em cidades sem agua fluoretada, com menor cobertura da rede de abastecimento de agua e com renda mediana baixa foram fatores contextuais associados a doenca. CONCLUSOES: A prevalencia de carie em criancas brasileiras de 12 anos foi baixa, de acordo com os criterios da Organizacao Mundial da Saude. Houve significantes desigualdades geograficas e socioeconomicas nos niveis da doenca.

Individual and contextual determinants of dental caries in Brazilian 12-year-olds in 2010

OBJECTIVE To estimate the prevalence and severity of dental caries in Brazilian children and the association with individual and contextual factors. METHODS Data were taken from the Brazilian Oral Health Survey (SBBrasil 2010) a sample of 7,247 12-year-olds. The data were collected using clinical examinations and interviews. The dependent variables were the prevalence of dental caries (decayed, missing and filled teeth [DMFT] ≥ 1 and DMFT ≥ 4). Bivariate (Rao Scott test) and multivariate (Poisson regression) analyses were carried out. The individual variables were sociodemographic variables, periodontal health and reporting discomfort while brushing. Contextual factors were the presence of water fluoridation, the percentage of residences connected to the water supply and median income of the municipality. RESULTS The prevalence of DMFT ≥ 1 was 56.0%. Mean DMFT was 2.04 (95%CI 1.76;2.31) and 22.2% of children had DMFT ≥ 4. Caries experience was significantly more common in children with black, brown or yellow skin; in low-income families; in children with dental calculus or bleeding gums and in those who reported discomfort while brushing. Living in towns with fluoridated tap water, with low coverage of water supply and with low median income were contextual factors associated with the disease. CONCLUSIONS The prevalence of dental caries in Brazilian 12-year-olds was low, according to World Health Organization criteria. There were significant geographical and socioeconomic inequalities in levels of the disease.OBJETIVO: Estimar a prevalencia e gravidade de carie em criancas brasileiras e sua associacao com fatores individuais e contextuais. METODOS: Foram utilizados os dados da Pesquisa Nacional de Saude Bucal (SBBrasil 2010), em uma amostra de 7.247 criancas de 12 anos. Os dados foram coletados por meio de exames clinicos e entrevistas. As variaveis dependentes foram as prevalencias de carie (dentes permanentes cariados, perdidos ou obturados [CPOD] ≥ 1 e CPOD ≥ 4). Foram realizadas analises bivariadas (teste de Rao-Scott) e multinivel (regressao de Poisson). As variaveis individuais foram sociodemograficas, condicao periodontal e relato de incomodo ao escovar os dentes. Os fatores contextuais foram a presenca de agua fluoretada, a porcentagem de domicilios ligados a rede de abastecimento de agua e a renda mediana do municipio. RESULTADOS: A prevalencia de CPOD ≥ 1 foi 56,0%. O CPOD medio foi igual a 2,04 (IC95% 1,76;2,31) e 22,2% das criancas tinham CPOD ≥ 4. A experiencia de carie foi significantemente mais elevada em criancas de cor de pele preta, parda e amarela; em familias com renda mais baixa; em criancas com calculo dentario ou sangramento gengival; e naquelas que relataram incomodo ao escovar. Viver em cidades sem agua fluoretada, com menor cobertura da rede de abastecimento de agua e com renda mediana baixa foram fatores contextuais associados a doenca. CONCLUSOES: A prevalencia de carie em criancas brasileiras de 12 anos foi baixa, de acordo com os criterios da Organizacao Mundial da Saude. Houve significantes desigualdades geograficas e socioeconomicas nos niveis da doenca.

Validação inicial do índice de necessidade de atenção à saúde bucal para as equipes de saúde bucal na estratégia de saúde da família

This survey set out to validate the Index of Oral Healthcare Needs (IOHN), based on a pre-defined algorithm of the social status of families. The validation process was divided into two phases, namely a face validation and a construct validation. In the latter, data on caries experience, toothache and access to oral health services was collected. To validate the index a random, stratified sample of 412 children aged 3-5 and 7-12 was obtained, based on the IOHCN algorithm, all the children being from the areas of Recife covered by the family healthcare program. The analysis consisted of a descriptive and an analytical phase, adopting a 5% level of significance. The index was considered by an expert committee to have good face validity. The convergent construct validation was associated with a decay component of dmft (p = 0.03) and DMFT (p = 0.01); the divergent construct validation was associated with access to oral care (p = 0.001) and filled component of dmft (p = 0.05), showing no association with the filled component of DMFT. The Index of Oral Healthcare Needs was shown to have good initial validation and canbe used as a useful tool in the planning of dental care at a local level.

Avaliação do cumprimento de atenção secundária em saúde bucal

Resumen pt: Objetivos: Avaliar o cumprimento da atencao secundaria em saude bucal em Pernambuco, nos CEO (Centro de Especialidades Odontologicas implantado ate 31 de...

Vigilância à saúde bucal: a construção de um modelo integrado

Although Brazil has a tradition of conducting nationwide epidemiological surveys such as the oral health surveys in 1986, 1996, and 2003, it was only in 2006 that the country created a specific policy for including oral health surveillance as a crucial component of both the National Oral Health Policy (PNSB) and the Ministry of Health’s overall health surveillance policy. In this context, it is imperative to establish a theoretical framework based on the field of surveillance and to determine the interfaces for building an oral health surveillance model, integrated with the prevailing health surveillance policy. Based on the essentially chronic nature of most oral health diseases, the model should attempt to integrate the various approaches. The first step is to adopt a surveillance model for chronic diseases, necessarily from the oral health perspective. This requires adopting new ways of measuring oral lesions and sequelae not only physically, but also in terms of their impact on quality of life. The new model should also focus on common risk factors, representing the principal information needed by countries, regions, and local health authorities for planning health promotion and primary prevention. This approach should also be considered in the construction of a future oral health information system. The surveillance system for chronic non-communicable diseases includes: (a) mapping trends and analyzing social, economic, behavioral, and political determinants to back health promotion policies and strategies; (b) reducing the level of individual and population exposure to the most common risk factors; (c) strengthening the health system for patient management; and (d) strengthening the respective local, regional, national, and international networks and partnerships. In December 2006, under Ministry Health Ruling SAS/MS 939/2006, Brazil created a national committee with various functions, including, in Article 4, advising the Oral Health Division of the Ministry in setting guidelines and strategies for oral health surveillance, based on epidemiological characteristics and organization of health services at the National, State, and Municipal levels, and proposing criteria for data validation in the information systems under the Unified National Health System (SUS), as well as strategies for institutionalization of monitoring and surveillance in oral health. Due to the relevance of chronic non-transmissible diseases as part of the epidemiological profile of the Brazilian population, the Ministry of Health, through the Health Surveillance Secretariat, has formed various partnerships between academic research institutions, States, and Municipalities to develop overall surveys for monitoring risk and protective factors and health problems and conditions. This Supplement discusses some of these surveys (e.g. VIGITEL, VIVA, and PENSE) that have already included issues related to oral health, besides the specific survey on the oral health conditions of the Brazilian population (SB-2010), highlighting the importance of consolidating the current initiative to structure the oral health surveillance component of the PNSB by extending this action to the State and Municipal levels. Oral health surveillance: building an integrated model

A Interface entre a Atenção Primária e os Serviços Odontológicos de Urgência (SOU) no SUS: a interface entre níveis de atenção em saúde bucal

Considering that emergency dental services include the referral network and the counter-referral network, interacting at the intersection between primary, secondary and tertiary healthcare, this study aims to describe the interface between primary healthcare (APS - Atenção Primária a Saúde), particularly of the Family Health Strategy, and secondary care in oral health, using the Emergency Dental Services (SOU), in the municipality of Recife. It is a qualitative, exploratory and descriptive case study. The data was collected through semi-structured interviews. Classical ALCESTE analysis was used based on the Descending Hierarchical Classification Dendrogram, making it possible to understand the expressions and each one of the words spoken by the dental health professionals, analyzing them using their social places and contexts as a starting point. What we found was only a fragile degree of integration, and little capacity for solution, between the levels of care - a partially disconnected network. Undoubtedly the problems with the interface between primary care and the emergency services in oral health are multiple and complex. The individual solutions have low efficacy, and are complex in their operation.Considering that emergency dental services include the referral network and the counter-referral network, interacting at the intersection between primary, secondary and tertiary healthcare, this study aims to describe the interface between primary healthcare (APS – Atencao Primaria a Saude), particularly of the Family Health Strategy, and secondary care in oral health, using the Emergency Dental Services (SOU), in the municipality of Recife. It is a qualitative, exploratory and descriptive case study. The data was collected through semi-structured interviews. Classical ALCESTE analysis was used based on the Descending Hierarchical Classification Dendrogram, making it possible to understand the expressions and each one of the words spoken by the dental health professionals, analyzing them using their social places and contexts as a starting point. What we found was only a fragile degree of integration, and little capacity for solution, between the levels of care – a partially disconnected network. Undoubtedly the problems with the interface between primary care and the emergency services in oral health are multiple and complex. The individual solutions have low efficacy, and are complex in their operation.

Avaliação de Serviços Odontológicos de Urgência (SOU): A Visão Dos Gestores, Gerentes e Profissionais

Resumen pt: Objetivo: Avaliar, sob a otica de gestores/gerentes e profissionais, a qualidade dos Servicos Odontologicos de Urgencia (SOU) da cidade do Recife, Brasil...

Determinantes individuales y contextuales de la caries en niños brasileños de 12 años en 2010

OBJECTIVE To estimate the prevalence and severity of dental caries in Brazilian children and the association with individual and contextual factors. METHODS Data were taken from the Brazilian Oral Health Survey (SBBrasil 2010) a sample of 7,247 12-year-olds. The data were collected using clinical examinations and interviews. The dependent variables were the prevalence of dental caries (decayed, missing and filled teeth [DMFT] ≥ 1 and DMFT ≥ 4). Bivariate (Rao Scott test) and multivariate (Poisson regression) analyses were carried out. The individual variables were sociodemographic variables, periodontal health and reporting discomfort while brushing. Contextual factors were the presence of water fluoridation, the percentage of residences connected to the water supply and median income of the municipality. RESULTS The prevalence of DMFT ≥ 1 was 56.0%. Mean DMFT was 2.04 (95%CI 1.76;2.31) and 22.2% of children had DMFT ≥ 4. Caries experience was significantly more common in children with black, brown or yellow skin; in low-income families; in children with dental calculus or bleeding gums and in those who reported discomfort while brushing. Living in towns with fluoridated tap water, with low coverage of water supply and with low median income were contextual factors associated with the disease. CONCLUSIONS The prevalence of dental caries in Brazilian 12-year-olds was low, according to World Health Organization criteria. There were significant geographical and socioeconomic inequalities in levels of the disease.OBJETIVO: Estimar a prevalencia e gravidade de carie em criancas brasileiras e sua associacao com fatores individuais e contextuais. METODOS: Foram utilizados os dados da Pesquisa Nacional de Saude Bucal (SBBrasil 2010), em uma amostra de 7.247 criancas de 12 anos. Os dados foram coletados por meio de exames clinicos e entrevistas. As variaveis dependentes foram as prevalencias de carie (dentes permanentes cariados, perdidos ou obturados [CPOD] ≥ 1 e CPOD ≥ 4). Foram realizadas analises bivariadas (teste de Rao-Scott) e multinivel (regressao de Poisson). As variaveis individuais foram sociodemograficas, condicao periodontal e relato de incomodo ao escovar os dentes. Os fatores contextuais foram a presenca de agua fluoretada, a porcentagem de domicilios ligados a rede de abastecimento de agua e a renda mediana do municipio. RESULTADOS: A prevalencia de CPOD ≥ 1 foi 56,0%. O CPOD medio foi igual a 2,04 (IC95% 1,76;2,31) e 22,2% das criancas tinham CPOD ≥ 4. A experiencia de carie foi significantemente mais elevada em criancas de cor de pele preta, parda e amarela; em familias com renda mais baixa; em criancas com calculo dentario ou sangramento gengival; e naquelas que relataram incomodo ao escovar. Viver em cidades sem agua fluoretada, com menor cobertura da rede de abastecimento de agua e com renda mediana baixa foram fatores contextuais associados a doenca. CONCLUSOES: A prevalencia de carie em criancas brasileiras de 12 anos foi baixa, de acordo com os criterios da Organizacao Mundial da Saude. Houve significantes desigualdades geograficas e socioeconomicas nos niveis da doenca.

Individual and contextual determinants of dental caries in Brazilian 12-year-olds in 2010 = Determinantes individuais e contextuais da cárie em crianças brasileiras de 12 anos em 2010

OBJECTIVE To estimate the prevalence and severity of dental caries in Brazilian children and the association with individual and contextual factors. METHODS Data were taken from the Brazilian Oral Health Survey (SBBrasil 2010) a sample of 7,247 12-year-olds. The data were collected using clinical examinations and interviews. The dependent variables were the prevalence of dental caries (decayed, missing and filled teeth [DMFT] ≥ 1 and DMFT ≥ 4). Bivariate (Rao Scott test) and multivariate (Poisson regression) analyses were carried out. The individual variables were sociodemographic variables, periodontal health and reporting discomfort while brushing. Contextual factors were the presence of water fluoridation, the percentage of residences connected to the water supply and median income of the municipality. RESULTS The prevalence of DMFT ≥ 1 was 56.0%. Mean DMFT was 2.04 (95%CI 1.76;2.31) and 22.2% of children had DMFT ≥ 4. Caries experience was significantly more common in children with black, brown or yellow skin; in low-income families; in children with dental calculus or bleeding gums and in those who reported discomfort while brushing. Living in towns with fluoridated tap water, with low coverage of water supply and with low median income were contextual factors associated with the disease. CONCLUSIONS The prevalence of dental caries in Brazilian 12-year-olds was low, according to World Health Organization criteria. There were significant geographical and socioeconomic inequalities in levels of the disease.OBJETIVO: Estimar a prevalencia e gravidade de carie em criancas brasileiras e sua associacao com fatores individuais e contextuais. METODOS: Foram utilizados os dados da Pesquisa Nacional de Saude Bucal (SBBrasil 2010), em uma amostra de 7.247 criancas de 12 anos. Os dados foram coletados por meio de exames clinicos e entrevistas. As variaveis dependentes foram as prevalencias de carie (dentes permanentes cariados, perdidos ou obturados [CPOD] ≥ 1 e CPOD ≥ 4). Foram realizadas analises bivariadas (teste de Rao-Scott) e multinivel (regressao de Poisson). As variaveis individuais foram sociodemograficas, condicao periodontal e relato de incomodo ao escovar os dentes. Os fatores contextuais foram a presenca de agua fluoretada, a porcentagem de domicilios ligados a rede de abastecimento de agua e a renda mediana do municipio. RESULTADOS: A prevalencia de CPOD ≥ 1 foi 56,0%. O CPOD medio foi igual a 2,04 (IC95% 1,76;2,31) e 22,2% das criancas tinham CPOD ≥ 4. A experiencia de carie foi significantemente mais elevada em criancas de cor de pele preta, parda e amarela; em familias com renda mais baixa; em criancas com calculo dentario ou sangramento gengival; e naquelas que relataram incomodo ao escovar. Viver em cidades sem agua fluoretada, com menor cobertura da rede de abastecimento de agua e com renda mediana baixa foram fatores contextuais associados a doenca. CONCLUSOES: A prevalencia de carie em criancas brasileiras de 12 anos foi baixa, de acordo com os criterios da Organizacao Mundial da Saude. Houve significantes desigualdades geograficas e socioeconomicas nos niveis da doenca.