Curative procedures of oral health and structural characteristics of primary dental care

OBJECTIVE: To evaluate if the provision of clinical dental care, by means of the main curative procedures recommended in Primary Health Care, is associated with team structural characteristics, considering the presence of a minimum set of equipment, instrument, and supplies in Brazil’s primary health care services. METHODS: A cross-sectional exploratory study based on data collected from 18,114 primary healthcare services with dental health teams in Brazil, in 2014. The outcome was created from the confirmation of five clinical procedures performed by the dentist, accounting for the presence of minimum equipment, instrument, and supplies to carry them out. Covariables were related to structural characteristics. Poisson regression with robust variance was used to obtain crude and adjusted prevalence ratios, with 95% confidence intervals. RESULTS: A total of 1,190 (6.5%) dental health teams did not present the minimum equipment to provide clinical dental care and only 2,498 (14.8%) had all the instrument and supplies needed and provided the five curative procedures assessed. There was a positive association between the outcome and the composition of dental health teams, higher workload, performing analysis of health condition, and monitoring of oral health indicators. Additionally, the dental health teams that planned and programmed oral health actions with the primary care team monthly provided the procedures more frequently. Dentists with better employment status, career plans, graduation in public health or those who underwent permanent education activities provided the procedures more frequently. CONCLUSIONS: A relevant number of Primary Health Care services did not have the infrastructure to provide clinical dental care. However, better results were found in dental health teams with oral health technicians, with higher workload and that plan their activities, as well as in those that employed dentists with better working relationships, who had dentists with degrees in public health and who underwent permanent education activities

Satisfacción de usuarios de servicios dentales públicos y privados para diferentes grupos de edad en Brasil

This article aimed to describe the levels of user satisfaction in different age groups and to study the association between user satisfaction and different types of dental services in a representative sample of Brazilians. This study is based on the Brazilian Oral Health Survey, which evaluated the dental health of adolescents, adults and older adults in 177 Brazilian cities. The outcome variable was user satisfaction, related to the last dental visit, evaluated in a five-level Likert-type scale. The main exposure variable was the type of dental service (public service, private service, health plan or insurance). The independent variables were DMFT (decay, missing and filled teeth); pain intensity in the past six months; reason for the last dental visit; perceived need for treatment; frequency of use of dental services; sex; equivalent income; and educational level. An ordered logistic regression analysis was performed separately for each age group. Few participants evaluated the services as bad or very bad (4.3% of adolescents, 6.1% of adults and 4.1% of older adults). In the crude model, the use of public services was associated with lower satisfaction than the use of private services and health plans between all groups. However, after adjusting by covariates, this association remained only in adolescents, who showed lower satisfaction with the public service compared to the private service and health plans. In general, Brazilians are satisfied with dental services, but, among adolescents, the use of public services was associated with lower satisfaction. Public services may be focused on issues related to children, adults and older adults, and not to the adolescent audience, which has specific demands.O artigo teve como objetivos descrever os níveis de satisfação de usuários de diferentes grupos etários e analisar a associação entre satisfação de usuários e diferentes tipos de serviços odontológicos em uma amostra representativa de brasileiros. O estudo é baseado na Pesquisa Nacional de Saúde Bucal, que avaliou a saúde oral dos adolescentes, adultos e idosos em 177 cidades brasileiras. A variável de desfecho era a satisfação do usuário em relação à última consulta odontológica, avaliada através da uma escala de tipo Likert, com cinco níveis. A principal variável de exposição era o tipo de serviço de saúde oral (público, privado, plano ou seguro odontológico). As variáveis independentes eram o índice CPOD (dentes cariados, perdidos e obturados); intensidade de dor nos últimos seis meses; motivo pela última consulta odontológica; percepção de necessidade de tratamento; frequência de uso de serviços de saúde oral; sexo; renda equivalente e escolaridade. Foram realizadas análises separadas de regressão logística ordinal para cada faixa etária. Poucos participantes avaliaram os serviços como ruins ou muito ruins (4,3% dos adolescentes, 6,1% dos adultos e 4,1% dos idosos). Entre todos os grupos, no modelo não ajustado, o uso de serviços públicos esteve associado à satisfação mais baixa em comparação com os serviços privados e planos de saúde. Entretanto, após ajustar pelas covariáveis, esta associação se manteve apenas nos adolescentes, que mostraram menor satisfação com os serviços públicos em comparação com os serviços privados e planos de saúde. Em geral, os brasileiros estão satisfeitos com os serviços de saúde oral; no entanto, entre os adolescentes o uso de serviços públicos esteve associado à menor satisfação. É possível que os serviços públicos estejam orientados para as questões das crianças, dos adultos e dos idosos, mas não do público de adolescentes, que apresentam demandas específicas.El objetivo de este artículo fue describir los niveles de satisfacción de los usuarios en diferentes grupos de edad, además de estudiar la asociación entre la satisfacción del usuario y los diferentes servicios dentales, en una muestra representativa de ciudadanos brasileños. Este estudio está basado en la Encuesta de Salud Bucal Brasileña, que evaluó la salud dental de adolescentes, adultos y adultos de edad avanzada en 177 ciudades brasileñas. La variable de resultado fue la satisfacción del usuario, en relación con la última visita dental, evaluada en una escala tipo Likert de cinco niveles. La variable principal de exposición fue el tipo de servicio dental (servicio público, servicio privado, plan de salud o seguro). Las variables independientes fueron DCPO (dientes cariados, perdidos y obturados); intensidad del dolor en los últimos seis meses; razón de la última visita dental; necesidad percibida de tratamiento; frecuencia del uso de los servicios dentales; sexo; ingresos equivalentes; y nivel educacional. Se realizó un análisis por regresión logística ordinario separadamente para cada grupo de edad. Algunos participantes evaluaron los servicios como deficitarios o muy deficitarios (4,3% de los adolescentes, 6,1% de los adultos y un 4,1% de los adultos de edad más avanzada). En el modelo sin estratificar, el uso de los servicios públicos estuvo asociado con una satisfacción más baja que el uso de servicios privados y planes de salud entre todos los grupos. No obstante, tras ser ajustado por las covariables, la asociación se mantuvo sólo en los adolescentes, que mostraron una satisfacción más baja con el servicio público, en comparación con los servicios privados y planes de salud. En general, los brasileños están satisfechos con los servicios dentales, sin embargo, entre los adolescentes, el uso de los servicios públicos estuvo asociado con una baja satisfacción. Los servicios públicos tal vez se centran en asuntos relacionados con niños, adultos y adultos de edad avanzada, y no con el público adolescente que demanda servicios específicos

Dental pain in homeless adults in Porto Alegre, Brazil

Objective To evaluate the association of dental pain with time living on the street in a sample of homeless people in the city of Porto Alegre, Brazil. Methods A cross-sectional study was carried out with homeless people who accessed social services in 2017. A questionnaire was administered covering socioeconomic variables and including questions about general health, use of tobacco/alcohol/drugs, use of dental services and history of dental pain. The decayed, missing, and filled teeth (DMFT) index was calculated in an oral examination. The association between socioeconomic characteristics, health status, time of homelessness and dental pain was evaluated using chi-square, t-, and Mann-Whitney tests. Results A total sample of 214 homeless people was surveyed. Most were male (76.2%), had a low level of education (67.6%) and experienced many episodes of dental pain during life (91.0%). The last episode of pain was moderate or intense (79.7%) and do-it-yourself measures for pain relief were preferred (62.3%). Individuals who were homeless for longer than 1 year had more dental pain in the past (P < 0.001), more frequency of a recent episode of dental pain (P = 0.03), and sought a dentist or healthcare service to relieve pain less frequently (P = 0.03). Conclusions Dental pain is frequent in the context of homelessness and does not necessarily result in seeking dental services, even where there is universal oral health care

Alveolar Bone Loss: A Shorter-Time Study Model in Mice

Mucoperiosteal flap surgery (MPS) of the mouth is conducted in several clinical situations. However, MPS  triggers a resorption process that leads to alveolar bone ridge loss. Rodents are routinely used in studies  evaluating alveolar bone loss (ABL), and the experimental time involved in these experiments is usually 21  days. This study aims at establishing whether the alveolar bone resorption area differs between 10 and 21  days after MPS in mice mandibles. MPS was performed in the vestibular aspect of the left mandible (LM)  of 20 male CF1 mice Mus domesticus. The right mandible (RM) was used as control. Animals formed identical  groups for each experimental time. Animals were euthanized 10 days (ten days group, TG) or 21 days  (twenty one days group, TWG) after the surgical procedure. All mandibles were hemisectioned, cleaned and  stained for stereomicroscopic inspection. Digital images were obtained and the alveolar bone loss area measured  (mm2) using image analysis software. The results demonstrate that a significant loss is observed in the  left mandible (LM) (Student’s t test, p&lt;0.01), as compared to the RM, in both groups. No statistically significant  difference was observed in the ABL area (p&gt;0.05) between TWG and TG. This investigation leads  to the conclusion that it is possible to reduce experimental times when using the MPS model in mice.

Atendimento odontológico na primeira infância no Brasil: da política pública à evidência

OBJECTIVE: To evaluate whether characteristics of health services, oral health team and dental surgeon are associated with provision of dental care for children up to five years old in Brazilian Primary Health Care. METHODS: A cross-sectional study was conducted with data from 18,114 oral health teams in Brazil, evaluated in 2014 by the National Program for Access and Quality Improvement in Primary Care. The study outcome was the proven performance of dental procedures on children up to five years old. Statistical analysis was performed by Poisson regression based on a hierarchical model, where the first level was composed of service organization variables, the intermediate level composed of unit planning characteristics, and the proximal level composed of variables related to dental surgeon characteristics. RESULTS: Prevalence of dental care performed by oral health teams was 80.9% (n = 14,239). Scheduled appointments and activities of education in health were positively associated with the outcome, as well as planning and programming activities for the population and monitoring and analysis of oral health indicators. Complementary training in public health, continuing education activities and career plan were variables related to dental surgeons associated with the service provision. CONCLUSIONS: One fifth of health units in Brazil do not provide dental care for children in early childhood. Health units’ well-structured organization and planning protocols are associated with the provision of this service, as well as better employment relationship and graduate activities for dental surgeons.OBJETIVO: Avaliar se características dos serviços de saúde, da equipe de saúde bucal e do cirurgião-dentista estão associadas à prestação de atendimento odontológico a crianças de até cinco anos de idade na atenção básica brasileira. MÉTODOS: Estudo transversal, com dados de 18.114 equipes de saúde bucal do Brasil avaliadas pelo Programa Nacional de Melhoria do Acesso e da Qualidade em 2014. O desfecho do estudo foi a realização comprovada de procedimentos odontológicos em crianças de até cinco anos de idade. A análise estatística foi feita por regressão de Poisson com base em um modelo hierárquico, sendo o primeiro nível composto por variáveis de organização do serviço, o nível intermediário por características de planejamento da unidade e o nível proximal por variáveis relacionadas ao cirurgião-dentista. RESULTADOS: A prevalência de realização do atendimento odontológico pelas equipes de saúde bucal foi de 80,9% (n = 14.239). Consultas agendadas e atividades de educação em saúde se associaram positivamente ao desfecho, bem como atividades de planejamento e programação para a população e o monitoramento e análise de indicadores de saúde bucal. Formação complementar em saúde pública, atividades de educação permanente e plano de carreira foram variáveis relacionadas aos cirurgiões-dentistas que se associaram à prestação do serviço. CONCLUSÕES: Um quinto das unidades de saúde do Brasil não realiza atendimento odontológico na primeira infância. Protocolos de organização e planejamento bem-estruturados nas unidades de saúde estão associados à realização desse atendimento, bem como melhores vínculos trabalhistas e atividades de pós-graduação para os cirurgiões-dentistas

Tratamento odontológico disponível e sua associação com a satisfação com os serviços de atenção primária à saúde acessados por idosos

Objetivo: Esta pesquisa objetiva avaliar se a presença de equipes de saúde bucal nas unidades de atenção primária à saúde do SUS está associada a maior satisfação com o serviço acessado. Material e método: Neste estudo, de delineamento transversal, entrevistaram-se 401 idosos nos distritos Lomba do Pinheiro e Partenon em Porto Alegre, selecionados através de um processo amostral por conglomerados, a partir do sorteio de setores censitários. Resultado: A Regressão de Poisson demonstrou que as variáveis idade e oferta de tratamento odontológico se mantiveram associadas com o desfecho, já as variáveis idade, número de dentes e presença de tratamento odontológico estiveram associados com maiores prevalências à satisfação com o serviço de saúde. Conclusão: Os resultados encontrados trazem novas contribuições para a qualificação do SUS, uma vez que o estudo demonstra a necessidade de valorizar e integrar as equipes de saúde bucal às equipes de APS, pois traz evidências da associação entre a presença da equipe de saúde bucal e a satisfação dos usuários idosos com o serviço de saúde acessado.Objective: This research evaluated whether having dental treatment available in the primary health care centers of the Brazilian Unified Health System was associated with greater satisfaction with the services accessed. The offering of dental care within the health service that elders usually access may improve their satisfaction with the services as a whole. Material and method: In this cross-sectional study, 401 elders living in the districts of Lomba do Pinheiro and Partenon in Porto Alegre, Brazil were interviewed. Elders were selected using a cluster sampling design process from census tract drawings. Result: Poisson Regression revealed that age and dental treatment supply were associated with outcome, and age, number of teeth, and the presence of dental treatment were associated with a higher prevalence of satisfaction with health services. Conclusion: These results provide new contributions for health system qualification because this study demonstrated the importance of having dental treatment available to improve the satisfaction of older people with the Primary Health Care (PHC) services accessed

Feedback on audit and action planning for dental caries control : a qualitative study to investigate the acceptability among interdisciplinary pediatric dental care teams

Introduction: American Indian and Alaska Native children suffer from the poorest oral health of all populational groups in the United States. Evidence-based practices (EBP) for caries control are well established, but systematically implementing such practices have proven difficult. Audit and feedback with goal setting, and action planning to implement these EBPs have not been tested or adapted for Alaska Native healthcare settings. The aim of this study was to investigate acceptability and perceived feasibility of an audit and feedback intervention for pediatric dental caries control among dental providers and patient stakeholders. Methods: The pilot program was implemented in two dental clinics from a tribal healthcare consortium in Alaska. Key-informant interviews were conducted to investigate the contextual, organizational, and behavioral facilitators and barriers to the implementation and expansion of the program. Interview transcripts were analyzed by two researchers using thematic analysis. Results: Eight key informants were interviewed twice (during and after the intervention period), and one once, for a total of 17 interviews. Patient stakeholders were not interviewed due to COVID-19 pandemic clinic closures and social isolation mandates. Three principal themes emerged: a positive organizational climate and culture fostered the acceptability of the program, the positive impacts of the program observed in the pediatric dental teams and the organization, and the challenges to implement the program including understanding the data reports, trusting the accuracy of the data, and competing priorities. Conclusions: The intervention of audit and feedback with goal setting and action planning was well accepted and perceived as feasible by the study participants given the financial and human resources provided by the research project. This qualitative study can inform the design and evaluation of process-oriented implementation strategies geared towards decreasing health inequities and improving health outcomes, such as dental caries in American Indian and Alaska Native children and adolescents

Presencia y extensión de los atributos de la atención primaria de salud en servicios dentales públicos de Porto Alegre, Río Grande do Sul, Brasil

The objective was to compare the presence and extension of primary health care (PHC) in oral health services using the PHC attributes according to three different types of PHC organizational arrangements: Family Health Strategy (FHS), Community Health Service (CHS) and Traditional Primary Care (TPC). This is a cross-sectional study carried out between 2011-2013, following a cluster random sampling strategy. Adult users were interviewed from 15 health services of that 6 were managed by the CHS, 4 by the FHS and 5 by the TPC and which had the same oral health team for at least two years. The final sample was 407 users interviewed using the Primary Care Assessment Tool - Oral Health of Adults evaluation instrument and a sociodemographic questionnaire. PHC scores were calculated and transformed on a scale ranging from 0 to 10. For high scores, the cut-off point > 5.5 was used. Most of the interviewees were females, for the three types of services. The performance of CHS and FHS was higher than those of TPC in almost all attributes (p 5,5. Nos três tipos de serviços, a maioria dos entrevistados era do sexo feminino. Em quase todos os atributos, o desempenho dos SSC e da ESF foi superior àquele da APT (p 5.5. La mayoría de los entrevistados fueron mujeres en los tres tipos de servicios. El desempeño de los SCS y ESF fue mayor que en la APS en casi todos los atributos (p < 0,05). La extensión de los atributos de la APS en servicios fue escasa (la puntuación general más alta fue 5,75 en SCS). El SCS fue el único servicio con la mitad de usuarios (83; 49,1%) servicios cualificados de salud bucal, contando con una puntuación general alta para APS. Por lo que se concluye que existen diferencias entre los modelos organizativos de APS, respecto a los servicios orales de salud. No obstante, hay muchas cosas que deben ser mejoradas en la orientación de los servicios orales de salud relacionados con la APS. Se necesitan más estudios para evaluar las diferencias en los servicios de APS en relación con la salud bucal

Preocupações sobre a estética dentária com qualidade de vida relacionada à saúde bucal em adultos no sul do Brasil

It aims to evaluate the association between dental appearance and Oral Health Related Quality of Life. Fifteen primary care services with dental services were selected in Porto Alegre, Brazil. Individuals were interviewed from a random sampling of households in the catchment area of the health centres. The outcome was having an OHIP14 score > 0 (any impact). The main exposures included self-reported tooth colour and position, perception of oral health and concern with dental aesthetics. Data were analysed with stepwise logistic regression. Of 1943 individuals contacted, 433 used public dental services in the last year. Seventy-three percent had some impact on quality of life, 35.2% and 47.5% reported stained and crowded teeth, respectively. Also, 22.2% had already tried bleaching their teeth. Individuals concerned with colour were 2.56 times (95% CI: 1.34-4.89) more likely to report any impact after adjusting for number of teeth, smoking and education. Concerns about tooth position, reporting stained or crowded teeth, age, sex and income were not significant (p > 0.30). There is a direct and independent association between concerns with tooth colour and quality of life. The effect of tooth colour on quality of life may be mediated by individuals’ perceptions of aesthetics.O objetivo do presente estudo foi avaliar a associação entre a aparência dos dentes com a qualidade de vida relacionada à saúde bucal. Quinze centros de atenção primária com serviços odontológicos foram selecionados em Porto Alegre, Brasil. Os indivíduos foram entrevistados a partir de uma amostragem aleatória de domicílios. O desfecho avaliado foi ter um escore de OHIP14 > 0. As exposições foram: cor e posição autorreferida dos dentes, percepção da saúde bucal e preocupação com a estética dental. Os dados foram analisados com regressão logística. De 1.943 indivíduos contatados, 433 utilizaram os serviços públicos odontológicos, dos quais 73% tinham algum impacto na qualidade de vida; 35,2% dentes manchados e 47,5% dentes apinhados. Além disso, 22,2% já haviam tentado clarear os dentes. Indivíduos preocupados com a cor tinham 2,56 vezes (IC 95%: 1.34-4.89) mais chances de relatar qualquer impacto após o ajuste para número de dentes, tabagismo e educação. Preocupações com a posição dos dentes, relato de dentes manchados ou apinhados, idade, sexo e renda não foram significativas (p > 0,30). Houve uma associação direta e independente entre as preocupações com a cor do dente e qualidade de vida. O efeito da cor do dente pode ser mediado pela percepção da estética