Sônia Cristina Lima Chaves

A efetividade do dentifrício fluoretado no controle da cárie dental: uma meta-análise

OBJETIVO: Realizar uma meta-analise sobre a efetividade da escovacao com dentifricio fluoretado na reducao da carie dental para calcular o efeito das diferentes hipoteses testadas. METODOS: Foram revisados artigos publicados sobre a efetividade da educacao em saude oral no periodo compreendido entre 1980 e 1998, indexados nas bases de dados Medline e Lilacs. Para avaliacao da qualidade dos artigos, foram utilizados os criterios de rigor metodologico de Kay & Locker apos serem submetidos a um comite de experts formado por pesquisadores I-A do CNPq. Dos 43 artigos identificados, 22 (51,2%) atingiram os criterios de rigor metodologico propostos. O calculo do tamanho do efeito da intervencao de cada estudo foi feito a partir das diferencas de resultados entre os grupos de teste e controle. O efeito global foi calculado para cada agrupamento de estudos segundo as hipoteses testadas. RESULTADOS: O aumento da concentracao do fluor parece estar associado com o aumento do efeito (reducao global = -0,17 IC 95% -0,22/-0,12). O maior percentual de reducao de carie foi verificado na comparacao entre dentifricios fluoretados e aqueles sem fluor (reducao global = -0,29 IC 95% -0,34/-0,24). A adicao de anti-microbianos (reducao global = -0,03 IC 95% -0,07/+0,02), diferencas nos sistemas abrasivos (reducao global = -0,02 IC 95% -0,09/+0,04) e diferencas nos principios ativos nao aumentam a efetividade dos mesmos (reducao global = -0,04 IC 95% -0,10/+0,01). CONCLUSOES: As maiores reducoes de carie foram encontradas nos estudos com escovacao supervisionada. A sintese confirmou a importância da escovacao com dentifricio fluoretado no controle da carie dental. Contudo, aponta para uma enfase nos aspectos medicamentosos relacionados ao controle da doenca, em detrimento de acoes educativas especificas. A heterogeneidade de resultados indica que sejam considerados os contextos de implantacao das praticas preventivas no processo de sua avaliacao.

A produção científica brasileira sobre a Estratégia Saúde da Família e a mudança no modelo de atenção

The variety of existing studies addressing the Family Health Strategy (ESF) and its role in the reorientation of the model of care in the country has motivated the systematization of the advances and limitations described in these studies. Thus, this study, from a review of the scientific production on this theme, analyzed if the ESF has been able to modify the model of care. Forty-one articles from the Scielo database published between 2002 and 2010 that fulfilled the inclusion criteria were analyzed. They were fully analyzed in terms of political-institutional, organizational or technical-care dimensions. The results show that despite the improvement in the work process in primary care, its replacement aspect was not seen in the majority of the studies. Universal expansion of access to the health services, extension of coverage and focus were predominant. The changes are observed when analyzed in light of the demand, with better attendance and connectivity. The most evident limits are in the lack of focus on health needs, as in the territorial issue, community participation and the social determinants addressed in an intersectoral way. Different degrees of the implementation of strategy were identified, though they have not yet resulted in system reorganization at local level.

Atenção à saúde bucal e a descentralização da saúde no Brasil: estudo de dois casos exemplares no Estado da Bahia

A comparative case study was performed in two selected municipalities in the State of Bahia, Brazil, to discuss the relationship between health system decentralization and characteristics of oral health services. A logical model was developed and submitted to an expert panel. Data were gathered through in-depth interviews, field observation, and analysis of secondary data from the National Health System database. The results point to the influence of municipal government characteristics on oral health practice. One municipality was classified as having an intermediate standard of oral health system implementation (50%), while the other showed only 11% implementation. The study showed that the decentralization process has not been accompanied by an effort to improve management capacity in the local oral health services, despite the transfer of funds to this area.

A utilização do Sistema de Informações Ambulatoriais (SIA-SUS) como instrumento para caracterização das ações de saúde bucal

Palavras-chave: descentralizacao; servicos odontologicos; sistema de informacao; politicas de saude bucal. Summary This study assessed the process of decentralization of oral health activities in Brazilian municipalities using data from the Outpatient Information System (SIA-SUS). A strategy for the evaluation of oral health care is proposed. A historical series (1995 to 2001) of oral health attendances was constructed for two Brazilian municipalities (A and B ) of Bahia State. Oral procedures were classified as: dental appointments, oral health community actions (OHCA), preventive individual procedures, dental fillings, surgery and periodontal procedures. An increase of outpatient attendances was observed for both municipalities (from 0.18 to 0.43 procedures/ person/year and from 0.21 to 0.33 procedures/person/year, respectively), as well as an increase of OHCA targeted to groups aged 5 to 14 years (from 0.00 to 0.58 OHCA/person/year for A and from 0.00 to 2.33 OHCA/person/year for B). Oral health community actions predominated in Municipality B. Regular registration of individual clinical procedures was observed but OHCA were not, showing the need of register standardization. The proposed methodology permitted an assessment of oral health activities in the study areas and could be useful for the evaluation of oral health care programs.

As práticas profissionais no campo público de atenção à saúde bucal: o caso de dois municípios da Bahia

This paper examines the working facilities and processes of dentists in the primary healthcare systems of two towns in Bahia State, Brazil, striving to analyze the extent to which factors related to dental care, training, placement and professional profiles influence their practices. Semi-structured interviews were conducted with nine dentists in both towns, with work process organization patterns in Municipality C being closer to the structuring principles of Brazils National Health System than in Municipality E. This seems to be related to management characteristics, with networking links among individual, collective, and preventive clinical activities and planning noted in Municipality C. Despite these differences, the practitioners presented similarities in terms of dual militancy and perceptions of the public and private healthcare fields. The hegemony of the private sector seems to be influencing the professional practices of dentists in the public health system.

As práticas preventivas no controle da cárie dental: uma síntese de pesquisas

A literature review was conducted on the effectiveness of measures to prevent dental caries. Articles published in scientific journals from 1980 to 1998 and indexed in MEDLINE were selected. Some 210 articles were found and their abstracts classified according to intervention strategies, type of research design, and observed effects. The most frequent preventive measures were the use of fluoride toothpaste (20.5%), fluoride mouthwash (17.2%), and occlusal sealants (18,1%). The main target population was schoolchildren 6-12 years old (53.8%) and teenagers (15.7%). Western Europe produced 58.7% of the articles on this subject, followed by United States (22.7%), Eastern Europe, Asia, Canada, and Latin America. No relationship was identified between program results (effective as opposed to ineffective studies) and the type of preventive practice and research design, indicating that other issues need to be investigated, such as the context of organizational implementation (where, how, and by whom prevention is implemented). Education in oral hygiene as a basic tool and key component in specific preventive action has received little research attention.Foi realizada uma revisao sistematica de trabalhos de pesquisa sobre a efetividade das acoes preventivas no controle da carie dental, publicados no MEDLINE no periodo compreendido entre 1980 e 1998. Foram localizados 210 artigos, sendo que seus resumos foram analisados segundo as estrategias de intervencao, os tipos de desenho de pesquisa utilizados e os efeitos. As praticas preventivas mais avaliadas foram os dentifricios com fluor (20,5%), os bochechos com fluor (17,2%) e os selantes oclusais (18,1%). Houve uma predominância de estudos em individuos na idade escolar entre 6 e 12 anos (53,8%). Observou-se um maior numero de trabalhos oriundos da Europa Ocidental (58,6%), seguidos dos Estados Unidos (20,4%). Nao foram encontradas relacoes entre o resultado (estudos efetivos e nao efetivos) e o tipo de estrategia avaliada, por um lado, e o tipo de desenho do estudo utilizado, por outro. Esse fato revela que outras explicacoes para a diversidade dos resultados devem ser buscadas, principalmente no que diz respeito ao contexto de implantacao dos programas (onde, como e quem os implementa). A educacao em saude oral esta sendo pouco descrita ou considerada nos estudos de intervencao isolados.

Accessibility to primary healthcare in the capital city of a northeastern state of Brazil: an evaluation of the results of a programme

Background Organisational barriers to primary healthcare are still relevant in developing countries. Although descriptive reports of some experiences focusing on improving accessibility have been published, few studies have evaluated specific interventions aimed at overcoming the organisational obstacles. Objective To evaluate the results of a project designed to improve accessibility to healthcare services in Salvador, Bahia, Brazil. Methodology An evaluative, cross-sectional, ex post facto study that included a control group was carried out in a random sample of 710 users of 25 healthcare units of the primary municipal healthcare network. The association between the project implementation degree and outcome variables was measured by prevalence ratios (PR) and statistical inference was based on Taylor series 95% CIs. Results Better access to primary healthcare was found in units in which the intervention had been implemented than in those in which it had not been implemented, particularly with respect to reducing avoidable queues, the waiting time for scheduling a consultation (PR=0.23; 95% CI 0.15 to 0.34); the time of arrival in the queue (PR=0.16; 95% CI 0.09 to 0.31) and the introduction of a system for scheduling appointments by telephone (PR=0.76; 95% CI 0.70 to 0.83). Conclusion Owing to the simplicity of the programme and the impact it achieved, it may be reproduced in other underdeveloped countries to improve access to healthcare services. In addition, some of the instruments may be used in routine programme evaluation.

Condições de saúde bucal de crianças na faixa etária pré-escolar, residentes em áreas de abrangência do Programa Saúde da Família em Salvador, Bahia, Brasil

OBJECTIVES: to determine the prevalence and severity of dental caries, malocclusions and gum damage in five-year-old preschool children resident in areas covered by the Family Health Program (PSF). METHODS: a cross-cutting study was carried out with five-year-old children examined by PSF dental health teams and as part of the Collective Procedures Program of the municipal health service of the city of Salvador, in the State of Bahia, Brazil, in 2005. The diagnostic criteria established by the World Health Organization and the Dental Health Project were used and the examinations were carried out in schools, creches or the childrens homes. RESULTS: the investigation involved 1,374 children. The prevalence of caries was 49.6% and the def-d (average number of decayed, extracted or filled teeth) 1.97, most of these being cases of caries (85.78%). The prevalence of gum damage was 7.40% and for slight and moderate/severe malocclusion, 24.90% and 12.70%, respectively. CONCLUSIONS: there was a high prevalence of severe dental problems that are easy to prevent and control by way of more effective educational, preventive and curative action during primary care for preschool-aged children in the municipality. The services epidemiology department could help to plan and oversee such action.

Características do acesso e utilização de serviços odontológicos em municípios de médio porte

Este estudo de corte transversal descreve as principais caracteristicas de acesso e utilizacao de servicos odontologicos basicos e especializados em dois municipios de medio porte da Bahia com 100% de cobertura da Estrategia de Saude da Familia. Realizou-se um inquerito com 2.539 individuos de idade acima de 15 anos em 952 domicilios. As principais variaveis analisadas foram a necessidade de saude bucal percebida, a procura pelo servico, a barreira de acesso organizacional e o tipo de servico e o procedimento utilizado. A utilizacao de servicos publicos odontologicos especializados foi de 11,7% e basicos de 26%. No municipio com maior utilizacao de servicos publicos odontologicos, foi menor o uso de servicos privados. A principal barreira de acesso situou-se na AP (Atencao Primaria), entre 5,0% e 15,2%. Observou-se pouca interface da atencao secundaria com a AP ja que apenas 16,6% dos usuarios retornaram a esse nivel de atencao. Pode-se concluir que a principal barreira de acesso, em municipios com realidades organizacionais e geograficas especificas parece se situar na AP. Acoes preventivas individuais foram pouco relatadas. Recomenda-se a reducao de barreiras de acesso na AP, bem como a instituicao de um protocolo que estimule a longitudinalidade do cuidado nesse nivel.

Avaliação da cobertura do Serviço Odontológico da Polícia Militar da Bahia em Salvador, Bahia, Brasil

This study seeks to evaluate dental care coverage in the State Military Police in Salvador, Bahia State, Brazil, from 2002 to 2004, estimating potential and real coverage rates. A single descriptive study was performed. Calculations were made of potential coverage rates considering hourly workloads of staff dentists and the real rates resulting from actual outpatient treatment. Potential human resources coverage was adequate (1 dentist per 1,618 policemen), while the real coverage rate was considered below the standard proposed by the Brazilian Ministry of Health (0.39 procedures per policeman per year). The low real coverage rate could be related to low productivity, the reasons for which should be investigated in greater depth in future studies, and might include organizational problems and lack of a management system to improve the quality of professional practice, with specifically defined targets.