Caries risk assessment in preschool children : a longitudinal study

Orientadores: Antonio Carlos Pereira, Glaucia Maria Bovi AmbrosanoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Esta tese, composta por dois estudos, teve como objetivos: a) Identificar os indicadores de risco de cárie dentária utilizando dados coletados no exame inicial e os preditores do incremento da doença após 18 meses de acompanhamento em crianças de 5 anos de idade (Capítulo 1); e b) Determinar a incidência de cárie dentária e avaliar a influência de variáveis socioeconômicas, clínicas e demográficas no tempo para o surgimento da doença em dentes permanentes numa coorte de crianças de 5 anos de idade, após 3 anos de acompanhamento (Capítulo 2). A amostra foi composta por 427 pré-escolares de 22 pré-escolas públicas de Piracicaba, SP, examinados em 2005 (baseline), após 18 meses (2006) e 36 meses (2008) pelo mesmo cirurgião-dentista previamente calibrado, sob luz natural, com espelho e sonda IPC. No exame inicial, o examinador coletou dados sobre variáveis clínicas (cárie dentária, lesão inicial de cárie - LI, gengivite, fluorose, apinhamento e espaçamento) socioeconômicas (renda familiar, número de pessoas na casa, escolaridade dos pais, habitação e posse de automóvel) e de hábitos orais deletérios (uso de chupeta e mamadeira). Após 18 e 36 meses, realizou-se o reexame para verificar a incidência de cárie. No primeiro estudo, para testar a associação entre as variáveis dependentes (experiência de cárie no baseline - ceos e incremento da doença - CPOS) e independentes (gênero, LI, experiência passada de cárie em dentes decíduos, gengivite, fluorose, apinhamento, espaçamento, renda familiar, número de pessoas na casa, escolaridade dos pais, habitação, posse de automóvel, uso de chupeta e mamadeira), uma análise bivariada foi conduzida utilizando-se o teste de Qui-quadrado ou o Exato de Fisher. Análise de regressão logística múltipla foi realizada, estimando os Odds Ratio (OR), os respectivos intervalos de 95% de confiança (IC) e os valores de p. A presença de LI (OR=10,69; IC=4,86-23,50) ou de gengivite (OR=1,54; IC=0,99-2,38), a ausência de espaçamento (OR=3,41; IC=1,39-8,40) ou de fluorose (OR=2,28; IC=1,17-4,44) foram considerados indicadores de risco de cárie no baseline (p<0,05). Os pré-escolares com experiência de cárie em dentes decíduos (OR=4,25; IC=1,95-9,27) ou de famílias com posse de automóvel (OR=2,27; IC=1,06-4,88) tiveram maior chance de desenvolver incremento da doença (p<0,05). Variáveis clínicas foram identificadas como indicadores e preditores de risco de cárie, e dentre as variáveis socioeconómicas avaliadas, somente posse de automóvel permaneceu como preditor de risco. No segundo estudo, utilizou-se o método de Kaplan-Meier para estudar o efeito isolado das variáveis socioeconómicas (renda familiar, número de pessoas na casa, escolaridade dos pais, habitação, posse de automóvel), clínicas (experiência passada de cárie em dentes decíduos, gengivite e fluorose) e demográfica (gênero) na incidência de cárie após 3 anos de acompanhamento. Um modelo de riscos proporcionais de Cox foi realizado para testar a influência das variáveis coletadas no exame inicial no tempo para o surgimento de incremento de CPOD. A análise de sobrevivência mostrou que crianças com experiência passada de cárie em dentes decíduos tiveram maior risco de desenvolver incremento de CPOD. Os resultados desta tese demonstraram que variáveis clínicas puderam identificar os pré-escolares com risco de apresentar ou desenvolver a doença e que a experiência passada de cárie continua sendo o principal e mais forte preditor de riscoAbstract: This thesis, composed of two papers aimed to: a) Identify the risk indicators of dental caries with data collected at initial examination and the predictors of disease increment based on the 18-months-follow-up examination in 5-year-old children (Chapter 1); e b) Determine the incidence of dental caries and evaluate the influence of socioeconomic, clinical and demographic variables on the time for disease to appear in the permanent teeth of a cohort of 5-year-old children after 3 years of follow-up (Chapter 2). The sample was composed by 427 preschool children from 22 public preschools in Piracicaba, SP, examined in 2005 (baseline), after 18 months (2006) and 36 months (2008) by the same calibrated dentist in an outdoor setting, under natural light, using a dental mirror and CPI probe. At initial examination, the dentist collected data on the clinical (dental caries, initial caries lesion - IL, gingivitis, fluorosis, crowding and spacing) and socioeconomic variables (family income, number of people living in the household, parents' educational level, home ownership and car ownership) and about deleterious oral habits (pacifier use and nursing bottle). Reexaminations were performed after 18 and 36 months to verify dental caries incidence. In the first paper, for testing the association between dependent variables (caries experience at baseline - dmfs and caries increment - DMFS) and independent variables (gender, IL, past caries experience in primary teeth, gingivitis, fluorosis, crowding, spacing, family income, number of people living in the household, parents' educational level, home ownership, car ownership, pacifier use and nursing bottle), a bivariate analysis was performed using the Chi-square or Fisher Exact tests. Logistic regression models were adjusted estimating the Odds Ratio (OR), 95% confidence intervals (CI) and p-values. Presence of IL (OR=10.69; CI=4.86-23.50) or gingivitis (OR=1.54; CI=0.99-2.38), absence of spacing (OR=3.41; CI=1.39-8.40) or fluorosis (OR=2.28; CI=1.17-4.44) were risk indicators for caries at baseline (p<0.05). The preschool children with caries experience in primary teeth (OR=4.25; CI=1.95-9.27) or from families with car ownership (OR=2.27; CI=1.06-4.88) were more prone to developing caries increment (p<0.05). Clinical variables were identified as risk indicators and risk predictors of dental caries and among socioeconomic variables tested only car ownership remained as risk predictor. In the second paper, the Kaplan-Meier survival analysis method was used to study the isolated effect of socioeconomic (family income, number of people living in the household, parents' educational level, home ownership and car ownership), clinical (past caries experience in primary teeth, gingivitis and fluorosis) and demographic (gender) variables on caries incidence after 3 years of follow-up. A Cox proportional hazards regression model was built to test the influence of the variables collected at initial examination on time to develop DMFT increment. Survival analysis showed that children with past caries experience in primary teeth would be at greater risk to developing DMFT increment. The results of this thesis demonstrated that clinical variables could identify the preschool children at risk to presented or developing the disease and the past caries experience continue to be the main and strongest risk predictorDoutoradoSaude ColetivaDoutor em Odontologi

Clinical and Social Variables Association on the Frequency of Intellectual Disability Persons to Dental Care

Objective: To evaluate the association of oral health indicators and social variables on the frequency of visit to the dentist by persons with intellectual disability (ID). Material and Methods: The study comprised a sample consisting of 149 participants with ID, aged from 11 to 29 years, from non-governmental institutions. Semi-structured interviews were held to collect sociodemographic and psychosocial information with their parents/guardians, followed by oral health evaluations in accordance with World Health Organization criteria. Crude analyses and multiple analysis were conducted to test whether oral health indicators and social data were predictors of the visit to dental care services. Results: In the multiple logistic regression model, individuals with lower DMF-t (OR=3.13; 95% CI=1.40-6.97) and those with less crowded housing (OR=2.33; 95% CI=1.06-5.12) presented less frequency of visits to oral health services. Conclusion: DMFT and crowded housing are associated to the frequency of persons with intellectual disability to dental care as well as this outcome measure affects the oral health of persons with ID. Therefore, identifying limiting factors to dental care of persons with intellectual disability is needed so that this group can receive adequate attention

Saúde bucal para pacientes com necessidades especiais: pesquisa avaliativa de Centros de Especialidades Odontológicas

ABSTRACT - The Dental Specialties Centers (CEOs) were created within the context of the National Oral Health Policy, and the main function of these establishments is to serve as units of reference in secondary oral health care in the Brazilian national health system (SUS), and they must offer at least the services of stomatology, specialized periodontology, minor oral surgery, endodontics, and attendance to patients with special needs. The aim of this study was to evaluate the quality of the CEOs in the mountain region of the Rio de Janeiro State, Brazil, in the perspective of the patients with special needs care or their companion’s satisfaction. Data were collected from 159 users by using a standardized self-applied individual semi-structured questionnaire. The results indicated a positive evaluation in most of the dimensions, except the accessibility dimension. Significant differences (p < 0.05) were observed between the services of the following dimensions of quality: accessibility, resoluteness, technical-scientific quality, efficiency, efficacy, and acceptability. The analysis of qualitative data, through the discourse of the collective subject technique (DCS) and social representations, showed five central ideas about users’ satisfaction and dissatisfaction with CEOs services (humanized health care, resoluteness of the service, professional competence, infrastructure and organization of the service, access to the services). In conclusion, most patients with special needs care and their companions were satisfied with specialized dental centers (SDC) services, although there were significant differences among SDCs services in relation to individuals’ satisfaction.RESUMO - Os Centros de Especialidades Odontológicas (CEOs) foram criados dentro do contexto da Política Nacional de Saúde Bucal e a principal função desses estabelecimentos é servir como unidades de referência em atenção secundária à saúde bucal no SUS, devendo oferecer pelo menos os serviços de estomatologia, periodontia especializada, cirurgia oral menor, endodontia e atendimento a pacientes com necessidades especiais. O objetivo deste estudo foi avaliar a qualidade dos Centros de Especialidades Odontológicas da região serrana do Estado do Rio de Janeiro, Brasil, por meio da satisfação dos pacientes com necessidades especiais ou de seus acompanhantes. Os dados foram coletados de 159 usuários utilizando um questionário semiestruturado individual auto-aplicado padronizado. Os resultados indicaram uma avaliação positiva na maioria das dimensões, exceto na acessibilidade. Diferenças significativas (p < 0.05) foram observadas entre os serviços nas seguintes dimensões de qualidade: acessibilidade, resolutividade, qualidade técnico-científica, eficiência, eficácia e aceitabilidade. A análise dos dados qualitativos, por meio da técnica do Discurso do Sujeito Coletivo (DSC) e das representações sociais, apresentou cinco ideias centrais sobre a satisfação e insatisfação dos usuários com os serviços dos CEOs (cuidado humanizado, resolutividade do serviço, competência profissional, infraestrutura e organização do serviço, acesso aos serviços). Em conclusão, a maioria dos pacientes com necessidades especiais e seus acompanhantes estavam satisfeitos com os serviços dos CEOs, embora houvesse diferenças significativas entre os serviços dos CEOs em relação à satisfação dos indivíduos.info:eu-repo/semantics/publishedVersio

Importance of recognizing the oral manifestations of systemic diseases and conditions by health professionals with diagnostic assignment

Objetivo: oferecer ao profissional de saúde, as principais informações contidas na literatura sobre as doenças com manifestações bucais, condições sistêmicas, e, sua importância no processo terapêutico. Metodologia: por meio de revisão da literatura, dividiu-se o assunto em quatro grandes blocos: estados de imunossupressão, síndromes, doenças infecciosas e dermatoses. Conclusão: o diagnóstico precoce representa melhora na qualidade de vida do paciente, na sua sobrevida e ainda na racionalização dos custos do tratamento.Aim: this paper aims to offer the healthcare professional, the main information contained in the literature on oral manifestations of systemic diseases and conditions and its importance in the therapeutic process. Methodology: through literature review, the subject was divided into four major blocks: from immunosuppression, syndromes, infectious diseases and skin diseases. Conclusion: it was concluded, among other things, that early diagnosis is improved quality of life of patients in its survival and further rationalization of the costs of treatment

Auto-percepção e má oclusão relacionadas à aparência e a função bucal

The aim of this study was to evaluate the relationship between malocclusion and self-perception of oral appearance/function, in 12/15-year-old Brazilian adolescents. The cluster sample consisted of 717 teenagers attending 24 urban public (n=611) and 5 rural public (n=107) schools in Maringá/PR. Malocclusion was measured using the Dental Aesthetic Index (DAI), in accordance with WHO recommendations. A parental questionnaire was applied to collect information on esthetic perception level and oral variables related to oral health. Univariate and multiple logistic regression analyses were performed. Multiple logistic regression confirmed that for 12-year-old, missing teeth (OR=2.865) and presence of openbite (open occlusal relationship) (OR=2.865) were risk indicators for speech capability. With regard to 15-year-old, presence of mandibular overjet (horizontal overlap) (OR=4.016) was a risk indicator for speech capability and molar relationship (OR=1.661) was a risk indicator for chewing capability. The impact of malocclusion on adolescents' life was confirmed in this study. Speech and chewing capability were associated with orthodontic deviations, which should be taken into consideration in oral health planning, to identify risk groups and improve community health services.Este estudo objetivou avaliar a relação entre a má oclusão e a autopercepção da aparência/função bucal em adolescentes brasileiros de 12/15 anos de idade. A amostragem foi probabilística, constituída por 717 adolescentes de escolas públicas, sendo 24 urbanas (n=611) e 5 rurais (n=107), em Maringá/PR. A má oclusão foi medida por meio do Índice de Estética Dental (DAI), de acordo com os critérios da OMS. Foi aplicado um questionário aos pais para coletar informações sobre o nível de percepção estética e as variáveis relacionadas à saúde bucal. Análises univariada e de regressão logística múltipla foram realizadas. A regressão logística múltipla confirmou que para 12 anos, os dentes ausentes (OR=2,865) e a presença de mordida aberta (OR=2,865) foram indicadores de risco na capacidade de fala. Com relação aos 15 anos, a presença de overjet mandibular (OR=4,016) foi um indicador de risco para a capacidade de expressão e a relação molar (OR=1,661) foi um indicador de risco para a capacidade mastigatória. O impacto da má oclusão na vida dos adolescentes foi confirmado neste estudo. A capacidade da fala e da mastigação esteve associada às alterações ortodônticas, as quais devem ser levadas em consideração no planejamento de saúde bucal, para identificar grupos de risco e para melhorar os serviços de saúde

Socioeconomic, familiar and clinical variables associated to caries increment in schoolchildren participating in a dental health program

To evaluate socioeconomic, familiar and clinical risk variables associated to caries increment in the children's permanent dentition from seven to 10 years participating in a dental health program. A sample of 301 children from nine public schools participated in the 'Always Smiling Program' took part in this study. They were evaluated for dental caries through dmft and DMF-T indexes along 2 years, and their parents completed a socio-environmental questionnaire containing questions on their income, education and family environment. Survival analysis using Kaplan-Meier method was used to evaluate the effect of the independent variables on caries increment. We verified that socio-environmental variables were not associated with caries increment, while children with experience in primary dentition were 1.5 times more likely to develop caries in permanent dentition compared to those who did not have this experience. Schoolchildren presenting dental caries in primary dentition on baseline had higher risk of developing caries in permanent dentition and this variable should be taken in consideration by managers of dental health programs when prioritizing groups with higher care needs.15112313

Estimativa do Índice CPOD usando os dentes mais afetados pela cárie dentária aos doze anos

The objective of the study was to develop regression models to describe the epidemiological profile of dental caries in 12-year-old children in an area of low prevalence of caries. Two distinct random probabilistic samples of schoolchildren (n=1,763) attending public and private schools in Piracicaba, Southeastern Brazil, were studied. Regression models were estimated as a function of the most affected teeth using data collected in 2005 and were validated using a 2001 database. The mean (SD) DMFT index was 1.7 (2.08) in 2001 and the regression equations estimated a DMFT index of 1.67 (1.98), which corresponds to 98.2% of the DMFT index in 2001. The study provided detailed data on the caries profile in 12-year-old children by using an updated analytical approach. Regression models can be an accurate and feasible method that can provide valuable information for the planning and evaluation of oral health services.O objetivo do estudo foi desenvolver modelos de regressão para delinear o perfil epidemiológico da cárie dentária em localidade com baixa prevalência de cárie aos 12 anos de idade. Foram examinadas duas amostras probabilísticas (n=1.763) de indivíduos de escolas públicas e privadas de Piracicaba,(SP). Dados sobre os dentes mais afetados foram coletados em 2005 e validados utilizando um banco de dados (2001). A média (dp) do CPOD foi de 1,7 (2,08) em 2001 e os modelos de regressão desenvolvidos estimaram um CPOD de 1,67 (1,98) em 2005, o qual representa 98,2% do CPOD em 2001. Os resultados apresentaram detalhes do perfil da cárie dentária aos 12 anos, usando uma abordagem analítica atual. Os modelos de regressão poderiam ser considerados como uma forma acurada e factível no auxílio do planejamento e avaliação dos serviços em saúde bucal.El objetivo de este estudio fue desarrollar modelos de regresión para describir el perfil epidemiológico de caries dentales en niños de 12 años en un área de baja prevalencia de caries. Fueron estudiados dos muestras distintas aleatorias y probabilísticas de niños escolares (n= 1.763) que estudiaban en colegios públicos y privados en Piracicaba, Sureste de Brasil. Modelos de regresión fueron estimados como una función de los dientes más afectados usando datos colectados en 2005 y fueron validados usando una base de datos del 2001. El índice promedio (SD) de DMFT fue 1,7 (2,08) en 2001 y las ecuaciones de regresión estimaron un índice de DMFT de 1,67 (1,98), lo cual corresponde a 98,2% del índice en 2001. El estudio provee datos detallados sobre el perfil de caries en niños de 12 años usando una aproximación analítica. Los modelos de regresión pueden ser un método confiable y factible que puede proporcional información valiosa para la planificación y evaluación de servicios de cuidado oral

Estimate Of Dmft Index Using Teeth Most Affected By Dental Caries In Twelve-year-old Children.

The objective of the study was to develop regression models to describe the epidemiological profile of dental caries in 12-year-old children in an area of low prevalence of caries. Two distinct random probabilistic samples of schoolchildren (n=1,763) attending public and private schools in Piracicaba, Southeastern Brazil, were studied. Regression models were estimated as a function of the most affected teeth using data collected in 2005 and were validated using a 2001 database. The mean (SD) DMFT index was 1.7 (2.08) in 2001 and the regression equations estimated a DMFT index of 1.67 (1.98), which corresponds to 98.2% of the DMFT index in 2001. The study provided detailed data on the caries profile in 12-year-old children by using an updated analytical approach. Regression models can be an accurate and feasible method that can provide valuable information for the planning and evaluation of oral health services.43179-8

Variables Associated With The Performance Of Centers For Dental Specialties In Brazil.

The aim of this study was to evaluate the performance of the Centers for Dental Specialties (CDS) in the country and associations with sociodemographic indicators of the municipalities, structural variables of services and primary health care organization in the years 2004-2009. The study used secondary data from procedures performed in the CDS to the specialties of periodontics, endodontics, surgery and primary care. Bivariate analysis by χ2 test was used to test the association between the dependent variable (performance of the CDS) with the independents. Then, Poisson regression analysis was performed. With regard to the overall achievement of targets, it was observed that the majority of CDS (69.25%) performance was considered poor/regular. The independent factors associated with poor/regular performance of CDS were: municipalities belonging to the Northeast, South and Southeast regions, with lower Human Development Index (HDI), lower population density, and reduced time to deployment. HDI and population density are important for the performance of the CDS in Brazil. Similarly, the peculiarities related to less populated areas as well as regional location and time of service implementation CDS should be taken into account in the planning of these services.17978-8

A assistência farmacêutica básica numa Comissão Intergestores Regional: avaliação e ação compartilhada para organização

ABSTRACT - Introduction: Determining how primary pharmaceutical assistance is structured allows us to establish situational diagnoses and to visualize possible implications for an essential part of the Brazilian Unified Health System. Methods: We evaluated pharmaceutical services of all municipalities that compose the Regional Inter-Agency Committee on Health of Ourinhos-São Paulo (CIR-Ourinhos-SP) through structure, process, and outcome indicators, and, in a shared way, we proposed actions to qualify the practice. We conducted direct observations of drugs, records, documents, interviews with pharmacists, and visits to health care centers, totaling 12 municipalities, 41 health care centers, and 3 pharmaceutical supply services. Results: In the thematic workshop carried out with municipal representatives, we found that 68.33% of health care centers and 70% of pharmaceutical supply services met good storage practices. We verified an average of 0.85 pharmacists per unit and the presence of 88.91% of marker drugs. Workshop proposals were sent to managers and pharmacists responsible for pharmaceutical assistance of 12 municipalities. Conclusions: Most indicators were below the established standards, demonstrating the need for adjustments in the infrastructure and provision of training for professionals.RESUMO - Introdução: A apuração de como as Assistências Farmacêuticas Básicas (AFB) municipais estão estruturadas permite o delineamento do diagnóstico situacional e visualização de possíveis implicações em parte essencial do Sistema Único de Saúde. Métodos: Avaliamos as AFB de todos os municípios que compõem a Comissão Intergestores Regional de Saúde de Ourinhos-SP (CIR-Ourinhos- SP), por meio de indicadores de estrutura, processo e resultado, e propôs-se, de forma compartilhada, ações para qualificar a prática. Foram realizadas observações diretas em medicamentos, cadastros, documentos, entrevistas com farmacêuticos, visitas às unidades de saúde (US), perfazendo 12 municípios, 41 US e 03 Centrais de Abastecimento Farmacêutico (CAF). Resultados: Na oficina temática realizada com os representantes municipais verificou- se, entre outras coisas, que 68,33% das US e 70% das CAF, cumpriam as boas práticas de armazenamento. Foi encontrada a média de 0,85 farmacêutico por unidade e presença de 88,91% de medicamentos marcadores. As propostas da Oficina foram encaminhadas aos gestores e farmacêuticos responsáveis pelas AFB dos 12 municípios. Conclusões: A maioria dos indicadores ficou abaixo dos padrões estabelecidos, demonstrando a necessidade de adequações na infraestrutura e de oferta de capacitações para as os profissionais.info:eu-repo/semantics/publishedVersio