Changes in Oral Health-Related Behaviors and Oral Health of Children in Early Childhood during Social Isolation Caused by COVID-19

ABSTRACT Objective: To assess changes in oral health-related behavior and oral health status in Brazilian children in early childhood perceived by their parents/caregivers during social isolation caused by COVID-19. Material and Methods: A cross-sectional study with parents/caregivers of children in southeastern Brazil aged 0-5 years who responded to an online questionnaire about sociodemographic data, dietary changes, oral hygiene, and oral health status of children during the COVID-19 pandemic. Results: Of the 119 parents/caregivers, 54.60% did not observe any changes in eating habits, and 81.50% maintained their children's oral hygiene. Associations were observed between the impact of the pandemic on the family income and changes in eating habits (p=0.02) and between lower family income and dental caries perceived by parents/caregivers (p=0.05). Z tests with Bonferroni correction showed that families with drastic income reduction were more likely to consume lower-cost foods (62.50%) than families with no impact or slight reduction on family income. Parents/caregivers did not identify dental caries (89.10%), toothache (92.40%), and dental trauma (92.40%) in their children. Conclusion: Parents/caregivers of children in southeastern Brazil aged 0-5 years observed behavioral changes in the dietary habits of families whose income was impacted by the pandemic, and their perception of dental caries was significantly associated with family income.

Atendimento odontológico de pacientes com necessidades especiais na atenção secundária em um estado do nordeste do Brasil / Dental care of special needs patients in secondary care in a northeastern state of Brazil / Atención odontológica a pacientes con necesidades especiales en la atención secundaria en un estado del nordeste de Brasil

O objetivo desse estudo foi descrever a produção dos atendimentos oferecidos aos pacientes com necessidades especiais nos Centros de Especialidades Odontológicas (CEO) da Paraíba (Brasil) e sua relação com o cumprimento das metas de produtividade, entre o período de 2019 e 2022. Trata-se de um estudo descritivo e ecológico em que foram coletados dados secundários do Sistema de Informações Ambulatoriais do SUS (SIA/SUS), através da captação da produção ambulatorial individualizada (BPA-I), por meio da ferramenta TabWin, dos 98 CEO operantes na Paraíba. Realizou-se análise descritiva e analítica, por meio dos testes Qui-Quadrado de Pearson e Exato de Fisher entre a variável dependente "alcance da meta" e a variável independente "adesão à Rede de Cuidados à Pessoa com Deficiência (RCPD)". Em todos os anos, a porcentagem de CEO cumpridores da meta (15,3% em 2019; 1% em 2020; 12,2% em 2021; e 11,2% em 2022) foi substancialmente menor que os números expressados por aqueles que não alcançaram a produção mínima. Os resultados também apontaram maior realização de procedimentos restauradores (29,6% em 2019; 28,6% em 2020; 32,7% em 2021; e 37,8% em 2022) em detrimento aos periodontais, cirúrgicos e preventivos. No que concerne a estar aderido à RCPD, no ano de 2022, 90,9% dos CEO que alcançaram a meta estavam aderidos à Rede (p<0,05). Concluiu-se que uma baixa frequência de CEO alcançou o cumprimento da meta de produtividade da especialidade de Odontologia para Pacientes com Necessidades Especiais nos CEO. No entanto, a adesão à RCPD manifestou-se como elemento influenciador para aqueles que cumpriram suas metas mensais e anuais.

The objective of this study was to describe the production of care provided to special needs patients in the Dental Specialties Centers (CEO) of Paraíba (Brazil) and its relationship with the achievement of productivity goals, between the period 2019 and 2022. This is a descriptive and ecological study in which secondary data were collected from the SUS Outpatient Information System (SIA/SUS), by capturing the individualized outpatient production (BPA-I), through the TabWin tool, of the 98 operating CEOs in Paraíba. We carried out descriptive and analytical analysis, using Pearson's Chi-square and Fisher's Exact tests between the dependent variable "goal attainment" and the independent variable "adherence to the Care Network for People with Disabilities (RCPD)". In all years, the percentage of CEOs meeting the goal (15.3% in 2019; 1% in 2020; 12.2% in 2021; and 11.2% in 2022) was substantially lower than the numbers expressed by those who did not meet the minimum output. The results also indicated greater performance of restorative procedures (29.6% in 2019; 28.6% in 2020; 32.7% in 2021; and 37.8% in 2022) to the detriment of periodontal, surgical, and preventive procedures. Regarding being adhered to the RCPD, in the year 2022, 90.9% of the CEOs who reached the goal were adhered to the Network (p<0.05). It was concluded that a low frequency of CEOs achieved compliance with the productivity target of the specialty of Dentistry for Special Needs Patients in CEOs. However, adherence to the RCPD manifested itself as an influential element for those who met their monthly and annual goals.

El objetivo de este estudio fue describir la producción de la atención prestada a pacientes con necesidades especiales en los Centros de Especialidades Odontológicas (CEO) de Paraíba (Brasil) y su relación con el alcance de las metas de productividad, entre el período de 2019 y 2022. Se trata de un estudio descriptivo y ecológico en el que se recogieron datos secundarios del Sistema de Información Ambulatoria del SUS (SIA/SUS), mediante la captura de la producción ambulatoria individualizada (BPA-I), a través de la herramienta TabWin, de los 98 CEOs en funcionamiento en Paraíba. Se realizaron análisis descriptivos y analíticos, utilizando las pruebas Chi-cuadrado de Pearson y Exacta de Fisher entre la variable dependiente "cumplimiento de metas" y la variable independiente "adhesión a la Red de Atención a Personas con Discapacidad (RCPD)". En todos los años, el porcentaje de directores generales que cumplieron el objetivo (15,3% en 2019; 1% en 2020; 12,2% en 2021; y 11,2% en 2022) fue sustancialmente inferior a las cifras expresadas por los que no alcanzaron el rendimiento mínimo. Los resultados también indicaron una mayor realización de procedimientos restauradores (29,6% en 2019; 28,6% en 2020; 32,7% en 2021; y 37,8% en 2022) en detrimento de los procedimientos periodontales, quirúrgicos y preventivos. Respecto a estar adherido a la RCPD, en el año 2022, el 90,9% de los CEOs que alcanzaron el objetivo estaban adheridos a la Red (p<0,05). Se concluyó que una baja frecuencia de CEOs alcanzó el cumplimiento de la meta de productividad de la especialidad de Odontología para Pacientes con Necesidades Especiales en CEOs. Sin embargo, la adhesión al RCPD se manifestó como un elemento influyente para aquellos que cumplieron sus objetivos mensuales y anuales.

Impact of oral onditions on Quality of Life in Peruvian Preschoolers in Rural and Urban Areas / Impacto de las alteraciones bucales en la calidad de vida de preescolares peruanos de zonas rurales y urbanas

Abstract The objective of this study is to determine the impact of oral conditions on the quality of life related to the oral health of preschool children in a rural and urban area of Cusco. The study was descriptive and cross-sectional, from a population of 179 preschoolers aged 3 to 5 years, from two public early childhood education institutions, and their respective parents or caregivers in the department of Cusco, Peru. We worked with the entire population that met the inclusion and exclusion criteria, seventy-four preschool children were selected for each area, deciding to have the same amount of children per group based on the smallest group. A clinical odonto-stomatological examination was carried out for oral conditions (dental caries, malocclusion, and dental trauma) according to the WHO's criteria and a survey that was used for sociodemographic characteristics. In addition, a validated Peruvian version of the ECOHIS questionnaire was used to obtain data on the impact on quality of life. All the variables of the total and individual scores of the ECOHIS domains were analyzed individually and the Kruskal-Wallis test was used to determine the association between variables. The oral conditions prevalence in preschool children in rural areas referring to dental caries was 100% (dmft index > 6), dental trauma 10.8%, and malocclusions 60.8%; for the urban area dental caries was 93.2% (dmft index > 6), dental trauma 9.5% and malocclusions 36.5%. Of the three oral conditions only the experience of dental caries was related to the OHRQOL of preschoolers in urban and rural areas.

Resumen El objetivo de este estudio es determinar el impacto de las alteraciones bucales en la calidad de vida relacionada con la salud bucal de niños preescolares de una zona rural y urbana de Cusco. El estudio fue descriptivo y transversal, de una población de 179 preescolares de 3 a 5 años de edad, de dos instituciones públicas de educación inicial, y sus respectivos padres o cuidadores en el departamento de Cusco, Perú. Se trabajó con toda la población que cumplió con los criterios de inclusión y exclusión, se seleccionaron setenta y cuatro niños preescolares por cada área, decidiendo tener la misma cantidad de niños por grupo en base al grupo más pequeño. Se realizó un examen clínico odonto-estomatológico para detectar alteraciones bucales (caries dental, maloclusión y trauma dental) según los criterios de la OMS y una encuesta que se utilizó para las características sociodemográficas. Además, se utilizó una versión peruana validada del cuestionario ECOHIS para obtener datos sobre el impacto en la calidad de vida. Todas las variables de los puntajes totales e individuales de los dominios ECOHIS fueron analizadas individualmente y se utilizó la prueba de Kruskal-Wallis para determinar la asociación entre variables. La prevalencia de alteraciones bucales en niños preescolares de zonas rurales referida a caries dental fue del 100% (índice dmft > 6), traumatismo dental 10,8% y maloclusiones 60,8%; para la zona urbana la caries dental fue del 93,2% (índice dmft > 6), el traumatismo dental 9,5% y las maloclusiones 36,5%. De las tres alteraciones bucales, sólo la experiencia de caries dental se relacionó con la OHRQOL de los preescolares de las zonas urbana y rural.

La Bioseguridad en los Servicios de Estomatología. Una Revisión Sistemática / Biosecurity in Stomatology Services, A Systematic Review

La odontología frente al virus SARS-CoV-2 ha sido calificada como la práctica que conlleva más riesgo comparado a otras profesiones en el ámbito de la salud, sobre todo porque el campo de trabajo es la cavidad oral, exponiéndose a diferentes agentes patógenos que podrían poner en riesgo la vida de los odontólogos, y ante el COVID-19 se expone esta preocupante realidad, por lo que a nivel internacional y local se han restructurado los protocolos de atención odontológica. El objetivo del presente estudio fue para concientizar la necesidad de prevenir la morbimortalidad por las infecciones cruzadas, mediante un espacio seguro, con la aplicación estricta de la bioseguridad para todos los que participan en la consulta estomatológica. La presente revisión ha encontrado coincidencias de criterios, así como, recomendaciones universales en la prevención de las infecciones cruzadas y manejo de la seguridad ante el riesgo de contagio.

Dentistry against the SARS-CoV-2 virus has been classified as the practice that carries more risk compared to other professions in the field of health, especially since the field of work is the oral cavity, exposing itself to different pathogens that could putting the lives of dentists at risk, and in the face of COVID-19 this worrying reality is exposed, so at the international and local level dental care protocols have been restructured. The objective of this study is to raise awareness of the need to prevent morbidity and mortality due to cross infections, through a safe space, with the strict application of biosafety for all those who participate in the stomatological consultation. The present review has found coincidences of criteria, as well as universal recommendations in the prevention of cross infections and management of safety in the face of the risk of contagion.

Potencialidades e limitações do Prontuário Eletrônico do Cidadão (PEC) enquanto ferramenta de gestão de cuidado e planejamento: avaliação a nível nacional e local / Potentials and limitations of the Electronic Citizen Record (PEC) as a care management and planning tool: assessment at national and local level

O objetivo desse estudo foi analisar as potencialidade e limitações do Prontuário Eletrônico do Cidadão (PEC) e comparar com os indicadores assistenciais de saúde bucal da Atenção Básica a nível nacional e de um município no interior do estado da Paraíba. A coleta de dados foi dividida em dois momentos: primeiro foram coletadas informações dos relatórios do e-SUS PEC presentes no site eletrônico e-Gestor do Departamento da Atenção Básica do Ministério da Saúde, referentes às equipes de saúde bucal das USF e em seguida a aplicação de um questionário estruturado para avaliar a aceitação, a facilidade e o uso do Prontuário Eletrônico do Cidadão (PEC) pelos cirurgiões dentistas cadastrados no município. Nos resultados, as regiões do Norte e Nordeste apresentaram os menores coeficientes de resolutividade (46,6 e 50,6) e com maior cobertura de primeira consulta odontológica (9,5 e 9,3), entretanto com maiores valores para exodontias (14,2 e 13,1); quanto à proporção de procedimentos preventivos observados, nota-se que o grau de priorização de cuidados de prevenção é alto em todas as regiões. Em nível local foram observadas variações significativas entre as USF; quanto ao uso do PEC 73,1% concordam que encontram mais rápido o prontuário no formato eletrônico e 61,5% concordam que o PEC otimiza seu processo de trabalho, já em relação ao manuseio do sistema 76,9% concordaram ser fácil. Portanto, existe uma disparidade de primeira consulta odontológica com a conclusão dos tratamentos e apesar de ser alta a cobertura de primeiro atendimento, mesmo assim, não é suficiente para evitar agravos dos problemas de saúde bucal, bem como o PEC é uma importante ferramenta que proporciona melhor assistência ao paciente, auxilia no atendimento, ajuda no planejamento de cuidados em saúde, facilita o acesso de dados (AU).

The objective of this study was to analyze and compare the potentialities and limitations of the Citizen's Electronic Record (PEC) with the oral health care indicators of Primary Care at national level and of a municipality in the interior of the state of Paraíba. Data collection will take place in two stages: first, information will be collected from the e-SUS PEC reports present on the e-Gestor website of the Department of Primary Care of the Ministry of Health, referring to the USF oral health teams, and then to application of a specific and objective questionnaire to assess acceptance, ease and use of the Citizen's Electronic Record (PEC) by dentists registered in the municipality. The results show that the Northeast and North have the lowest resolubility coefficients (46.6 and 50.6) and the highest coverage of the first dental appointment (9.5 and 9.3), however with higher values for extractions (14.2 and 13.1); as for the proportion of preventive procedures observed, it is noted that the degree of prioritization of preventive care is high in all regions and at the local level, significant variations were observed between USF; regarding the use of the PEC, 76.9% did not receive qualification or training, 23.1% always experience difficulties when handling it and 46.2% are sometimes able to operate all the functions of the system. Therefore, there is a disparity between the first dental visit and the completion of treatments and, despite the high coverage of the first visit, even so, it is not enough to avoid worsening oral health problems, as well as the PEC is an important tool that provides better patient care, assist with care, help with health care planning, facilitate data access (AU).

Disposición hacia la colaboración médica internacional en estudiantes de Estomatología de ocho universidades cubanas / Willingness towards international medical collaboration in dental students from eight Cuban universities

Introducción: Cuba se ha caracterizado por enviar a diversos países delegaciones de salud, llamadas "misiones médicas". Sin embargo, el interés de los futuros profesionales de formar parte de esas delegaciones no se ha investigado. Objetivos: Caracterizar la disposición hacia la colaboración médica internacional e identificar los factores asociados en estudiantes cubanos de Estomatología. Métodos: Se realizó una investigación transversal, analítica de datos secundarios, en estudiantes de todos los años del curso académico 2018-2019, pertenecientes a ocho universidades. La variable dependiente fue el reporte de la disposición de ir a misiones médicas. Se calcularon las razones de prevalencia e intervalos de confianza al 95 por ciento. Resultados: Participaron 1174 estudiantes, de los cuales 830 (71 por ciento) estuvieron dispuestos a cumplir misiones médicas. Existió una mayor disposición hacia la colaboración médica conforme aumentaba la edad (RPa: 1,02; IC 95 por ciento: 1,00-1,04; p = 0,044); así como, en los estudiantes que reportaron presión familiar para estudiar la carrera (RPa: 1,17; IC 95 por ciento: 1,09-1,26; p < 0,001). Aquellos que reportaron buenas notas antes de ingresar a la universidad (RPa: 0,83; IC 95 por ciento: 0,77-0,91; p < 0,001), los de solvencia económica (RPa: 0,90; IC 95 por ciento: 0,90-0,98; p = 0,019) y los que estaban cursando el tercer y cuarto años académicos (RPa: 0,93; IC 95 por ciento: 0,88-0,97; p = 0,003) fueron los de menor disposición para colaborar; ajustado por el sexo y la universidad. Conclusión: Existe una elevada disposición hacia la colaboración médica internacional y está asociada a múltiples aspectos sociales y educativos(AU)

Introduction: Cuba has been characterized by sending health delegations to various countries, called "medical missions". However, the interest of future professionals in joining those delegations has not been investigated. Objectives: Characterize the disposition towards international medical collaboration and identify the associated factors in Cuban students of Stomatology. Methods: A cross-sectional research and secondary data analytics was carried out in students of all years of the academic year 2018-2019, belonging to eight universities. The dependent variable was the report of the willingness to go on medical missions. Prevalence ratios and 95 percent confidence intervals were calculated. Results: 1174 students participated, of which 830 (71 percent) were willing to fulfill medical missions. There was a greater willingness towards medical collaboration as age increased (RPa: 1.02; 95 percent CI 1.00-1.04; p = 0.044); as well as, in students who reported family pressure to study the career (RPa: 1.17; 95 percent CI 1.09-1.26; p < 0.001). Those who reported good grades before entering college (RPa: 0.83; 95 percent CI 0.77-0.91; p < 0.001), those of economic solvency (RPa: 0.90; 95 percent CI 0.90-0.98; p = 0.019) and those who were in the third and fourth academic years (RPa: 0.93; 95 percent CI 0.88-0.97; p = 0.003) were those with the least willingness to collaborate; adjusted by sex and college. Conclusion: There is a high disposition towards international medical collaboration and it is associated with multiple social and educational aspects(AU)

O absenteísmo nos serviços públicos odontológicos / Universidade de São Paulo. Faculdade de Saúde Pública

As ausências dos pacientes às consultas acarretam perda de recursos públicos e comprometem a continuidade e a integralidade da assistência. Apesar de haver constante procura pelo serviço de saúde bucal, uma considerável parcela dos pacientes agendados não comparece às consultas, muitas vezes sem justificar essas faltas posteriormente. Diante disso, o objetivo deste estudo foi analisar os motivos que levaram os usuários de uma USF a faltar às consultas odontológicas. Após esta análise, objetivou-se implementar estratégias em conjunto com a equipe de saúde bucal para o enfrentamento do absenteísmo. Para o desenvolvimento desta pesquisa foram utilizadas as metodologias quantitativa e qualitativa de análise, esta última abordada com o recurso entrevista semiestruturada. Os dados obtidos foram submetidos à análise temática. A taxa de absenteísmo no período estudado foi de aproximadamente 24%. Para justificar essas ausências temos que 30% dos entrevistados relataram que o horário da consulta coincidiu com o horário de trabalho, 17% relataram que o motivo foi o relacionamento estabelecido pela equipe, 13% disseram ter esquecido o agendamento. O fato de o presente estudo ter relacionado aspectos e percepções referentes ao tema absenteísmo por parte da equipe de saúde bucal em associação com as respostas dos pacientes foi de suma importância para despertar um cenário de escuta, garantindo um permanente despertar de novos pensamentos, estratégias e releituras de práticas para o enfrentamento do absenteísmo.

Desempenho das equipes de saúde bucal no Brasil em relação às ações de atenção primária à saúde / Performance of oral health teams in Brazil in relation to primary health care actions

O "Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica ­ PMAQ-AB" foi lançado em 2011 pelo Ministério da Saúde, com objetivo de induzir a ampliação do acesso e a melhoria da qualidade da Atenção Primária em Saúde (APS) no Sistema Único de Saúde (SUS). O programa foi organizado em quatro fases que se complementam e conformam um ciclo contínuo: adesão e contratualização; desenvolvimento; avaliação externa e recontratualização. Com esse desenho, o PMAQ-AB buscou superar desafios para a qualificação da APS. O objetivo deste estudo foi descrever, analisar e compreender o desempenho das Equipes de Saúde Bucal (ESB) participantes do PMAQ-AB, por meio dos procedimentos odontológicos realizados, comparando os achados entre os ciclos e entre as regiões brasileiras. Utilizaram-se dados secundários do 2º e 3º ciclos do PMAQ-AB, ocorridos entre 2013 e 2019. Os dados foram obtidos na fase de avaliação externa, que envolveu entrevista com dentistas sobre o processo de trabalho das equipes. Este trabalho resultou em três artigos científicos. O primeiro e segundo artigo utilizaram dados do 3º Ciclo. No primeiro artigo realizou-se uma análise descritiva de 26 procedimentos odontológicos realizados na APS. Cada procedimento realizado atribuiu uma pontuação à ESB, sendo a pontuação final a soma do número de procedimentos realizados. Estas pontuações foram comparadas entre as regiões do país. Os resultados revelaram que as equipes realizaram, em média, 19,45 (±3,16) dos 26 procedimentos odontológicos analisados. As ESB do Sul, Sudeste e Nordeste realizaram um número maior de procedimentos, enquanto as equipes do Norte e Centro-Oeste realizaram, em média, menos procedimentos. No segundo artigo, foram avaliados 13 procedimentos (itens) relacionados a procedimentos odontológicos espontâneos, preventivos, cirúrgico, restauradores, protético e de câncer bucal. A Teoria da Resposta ao Item (TRI) foi utilizada para estimar as pontuações de desempenho das ESB, com base nos itens. A relação entre os escores de desempenho e as variáveis contextuais (Índice de Desenvolvimento Humano - IDH, e Índice de Gini) nas regiões brasileiras foi analisada por mapas temáticos e correlação de Pearson (p<0,05). Os procedimentos com maiores níveis de dificuldade e menos frequentemente realizados foram aqueles relacionados a próteses dentárias e monitoramento do câncer bucal. Os itens foram mais apropriados para discriminar ESB com baixo desempenho, e relativamente ineficazes para diferenciar aquelas com melhor desempenho. Os mapas temáticos mostraram uma relação direta com o IDH (p < 0,0001) e uma relação indireta com o índice de Gini (p= 0,0001). No terceiro artigo realizou-se um estudo comparativo do desempenho das equipes das ESB que participaram dos dois últimos ciclos de avaliação do PMAQ-AB, analisando 11 procedimentos odontológicos coincidentes nestes ciclos. A TRI foi utilizada para estimar os escores de desempenho das ESB em cada ciclo e esses escores foram comparados pelo teste de Wilcoxon (p ≤ 0,05), para o Brasil e regiões brasileiras. Os achados indicam que houve melhora nos escores de desempenho das ESB entre os dois ciclos no Brasil e nas regiões brasileiras. As regiões Nordeste, Centro-Oeste e Norte apresentaram as maiores evoluções. Porém, diferenças regionais ainda persistem, sendo necessário estruturar e melhorar as políticas públicas a fim de expandir e qualificar o processo de trabalho dos serviços de saúde bucal, promovendo uma melhor distribuição regional das ESB, a fim de reduzir as desigualdades.

The "National Program for Improvement of Primary Care Access and Quality - PMAQAB" was launched in 2011 by the Ministry of Health, aiming to induce the expansion of access and improvement of the quality of Primary Health Care (PHC) in the Unified Health System (SUS). The program was organized into four phases that complement each other and form a continuous cycle: adherence and contractualization; development; external evaluation and recontractualization. With this design, the PMAQ-AB sought to overcome challenges for the qualification of PHC. The objective of this study was to describe, analyze, and understand the performance of the Oral Health Teams (OHT) participating in PMAQ-AB, through dental procedures performed, comparing the findings between cycles and between Brazilian regions. Secondary data from the second and third cycles of PMAQ-AB, which occurred between 2013 and 2019, were used. The data were obtained in the external evaluation phase, which involved interviewing dentists about the work process of the teams. The first and second article used data from the third cycle. In the first article, a descriptive analysis of 26 dental procedures performed in the PHC was done. Each procedure performed attributed a score to the OHT, and the final score was the sum of the number of procedures performed. These scores were compared among the regions of the country. The results revealed that the OHTs performed, on average, 19.45 (±3.16) of the 26 dental procedures analyzed. The OHTs from the South, Southeast and Northeast performed a higher number of procedures, while the teams from the North and Midwest performed, on average, fewer procedures. In the second article, 13 procedures (items) related to spontaneous, preventive, surgical, restorative, prosthetic, and oral cancer dental procedures were evaluated. Item Response Theory (TRI) was used to estimate the OHT performance scores based on the items. The relationship between performance scores and contextual variables (Human Development Index - HDI, and Gini Index) in Brazilian regions was analyzed by thematic maps and Pearson correlation (p<0.05). The procedures with higher levels of difficulty and less frequently performed were those related to dental prostheses and oral cancer monitoring. The items were more appropriate to discriminate low performing OHT and relatively ineffective to differentiate those with better performance. The thematic maps showed a direct relationship with HDI (p < 0.0001) and an indirect relationship with Gini index (p= 0.0001). In the third article, a comparative study of the performance of the ESB teams that participated in the last two PMAQ-AB evaluation cycles was carried out, analyzing 11 dental procedures coincident in both cycles. IRT was used to estimate the performance scores of the OHT. After obtaining the performance scores of the second and third cycles, these scores were compared by the Wilcoxon signed-rank test (p ≤ 0.05) in Brazil and Brazilian regions. The findings indicate that there was improvement in the performance scores of the ESBs between the two cycles in Brazil and in the Brazilian regions. Northeast, Midwest, and North regions showing the greatest evolutions. However, regional differences still persist, and it is necessary to structure and improve public policies in order to expand and qualify the work process of oral health services, promoting a better regional distribution of the ESB in order to reduce inequalities.

Specialized Dental Care in the Brazilian Unified National Health System (SUS)

ABSTRACT Objective: To analyze specialized dental care through access, demand and the work processes provided by the CEO's, using secondary data from the cycles of the PMAQ-CEO. Material and Methods: Cross-sectional study using public domain data. Variables of interest were selected from the external evaluation instrument data matrices and were grouped in categories. The categories were geographic distribution, structural, human resources, work processes and access and coordination. Results: The total of 932 CEO's were evaluated in 2014 and 1,042 in 2016, most of them type II, present in the Northeast region. In both cycles, the highest average of dentists worked in the endodontic specialty (2.4 professionals per CEO) and the lowest in oral medicine (0.8 professionals per CEO). Of the two cycles, 91.5% of the CEO's had a manager, 79.5% performed action planning activities and 74.5% realized internal self-assessment processes. There was an increase in the mean number of days to be seen at the CEO in all analyzed specialties (p<0.001) and 85.2% of the CEO's managers reported that there is a reference for oral cancer confirmed cases. Conclusion: Between the PMAQCEO cycles the number of CEO has increased, but there are still a big pent-up demand and the presence of care gaps. However, an expansion and improvement of the CEO's actions was evidenced, mainly related to the work processes.

Parents' sense of coherence in the use of dental services by children aged 12 years old in the city Manaus/AM

Aim The aim of this study was to evaluate the association between the sense of coherence (SOC) of parents/guardians and the use of dental services by children who are 12 years old. Methods This is a cross-sectional study conducted in the eastern zone of the city of Manaus, with 358 children enrolled in the 7th grade in the municipal public school system. Data collection was performed through self-administered questionnaires sent to parents/guardians, which contained questions about socioeconomic conditions, use of dental services by children and Antonovsky's SOC-13 scale. Data were examined by descriptive and bivariate analysis, using the Chi-square test, with a 5% significance level. Results Of the 358 children, 58.4% were female; in addition, 75.4% of the parents/guardians self-reported to be brown and 39.9% of them had a family income of ½ to 1 minimum wage. SOC was categorized as strong SOC and weak SOC by the median. The association between strong or weak SOC and the use of dental services in terms of frequency (p= 0.839) and reason for last visit (p= 0.384), was not significant. Conclusion It was concluded that SOC of parents/guardians and utilization of dental services by children were not associated.

Effect of Quality of Dental Health Services to Patient Satisfaction in Indonesia 2019: Importance-Performance Analysis

ABSTRACT Objective: To determine the effect of the quality of dental health services based on dimensions of empathy and responsiveness to patient satisfaction in urban and rural areas in Bone District, Indonesia. Material and Methods: This survey used an analytical observational method with a pilot pathfinder survey design. The total of participants included in this survey was 442, with 223 in the urban area and 219 in the rural area. This survey was held on 25 February - 1 March 2019. The Mann-Whitney test was applied, adopting a significance level of 5%. Results: Empathy and responsive dimensions in urban (3.58 ± 0.94 and 3.50 ± 0.94) and rural (3.43 ± 0.99 and 3.63 ± 0.86) areas were in the moderate category. The administration staff was able to complete administrative procedures, and the Dental assistant responded promptly to the patient's request and needs. Conclusion: The quality of empathy and responsiveness dimensions in dental treatment fall in the moderate category for urban and rural areas; this means that empathy and responsiveness dimensions in dental service in hospital/public health need to be improved.

Autopercepção da saúde bucal e fatores associados em pessoas idosas quilombolas: um estudo de base populacional / Self-perception of oral health and associated factors in quilombola older people: a population-based study

Resumo Objetivo investigar a autopercepção das condições bucais e fatores associados em idosos quilombolas rurais do norte de Minas Gerais, Brasil. Método Trata-se de um estudo analítico e transversal de base populacional, no qual utilizou-se uma amostragem por conglomerados com probabilidade proporcional ao tamanho (n=406). A coleta de dados envolveu a realização de entrevistas e exames clínicos odontológicos. A autopercepção das condições bucais foi avaliada por meio do GOHAI (Índice de Determinação da Saúde Bucal Geriátrica). Resultados A maioria dos idosos autopercebeu a saúde bucal como ótima (46,3%) ou regular (30,2%). Os pesquisados revelaram ainda precária saúde bucal e acesso restrito aos serviços odontológicos. Verificaram-se, na análise múltipla, associações significantes (p˂0,05) entre GOHAI regular e variáveis relativas ao local da última consulta e uso de prótese, bem como entre GOHAI ruim e variáveis atinentes ao estado conjugal, religião, motivo da última consulta, índice CPO-D e uso de prótese. Conclusão Parcela expressiva dos idosos quilombolas manifestou uma autoavaliação mais positiva da saúde bucal, divergente do quadro odontológico constatado profissionalmente. Constatou-se ainda que o relato de percepção ruim das condições bucais esteve fortemente associado a uma saúde bucal mais precária entre os investigados.

Abstract Objective to investigate self-perception of oral conditions and associated factors in rural quilombola older people in northern Minas Gerais, Brazil. Method This is an analytical and cross-sectional population-based study, in which cluster sampling with probability proportional to size (n=406) was used. Data collection involved conducting interviews and clinical dental examinations. Self-perception of oral conditions was assessed using the GOHAI (Geriatric Oral Health Determination Index). Results Most older people self-perceived oral health as excellent (46.3%) or regular (30.2%). Those surveyed also revealed precarious oral health and restricted access to dental services. In the multiple analysis, significant associations (p˂0.05) were found between regular GOHAI and variables related to the location of the last consultation and use of prosthesis, as well as between poor GOHAI and variables related to marital status, religion, reason for last consultation, CPO-D index and use of prosthesis. Conclusion A significant portion of the quilombola older people showed a more positive self-assessment of oral health, which differs from the professionally verified dental condition. It was also found that the report of poor perception of oral conditions was strongly associated with poorer oral health among those investigated.

Prevalence of Dental Fear and its Association with Painful Oral Conditions in Adolescents

ABSTRACT Objective: To estimate the prevalence of dental fear and evaluate its association with dental caries and with Molar Incisor Hypomineralization (MIH) in schoolchildren aged 11-14 years. Material and Methods: A cross-sectional study was conducted with 375 adolescents in Campina Grande, Brazil. Socioeconomic and oral health information was collected, while dental fear was measured using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). The diagnosis of dental caries and MIH was performed by three trained examiners (κ ≥ 0.61) using the International Caries Detection & Assessment System - ICDAS II and a previously validated index, respectively. Data were descriptively analyzed using the Chi-Square, Fisher's Exact, and Poisson regression tests with robust variance (p<0.05). Results: The prevalence of dental fear was 18.4%, and the mean CFSS-DS total score was 28.96 ± 8.92. After adjusting for covariates family structure, schooling of parents/guardians, type of dental health service and dental pain in the last six months, the prevalence of dental fear was associated with dental pain in the last six months (PR=2.03; 95%CI=1.31-3.16; p=0.002). Conclusion: Although no association was found between dental fear, dental caries and MIH in adolescents, those who experienced dental pain in the last six months had a higher prevalence of dental fear.

Oral Health: Work Process and Interdisciplinarity

ABSTRACT Objective: To contribute to the debate about tools that favor the organization of the health work process and its interface with interdisciplinary practices. Material and Methods: We opted for a textual construction based on more specific publications on the field of oral health care. Results: The matrix support is configured as a method of inter-professional activity in co-management that aims to favor the qualification of the health care network. From this perspective, it is an interdisciplinary practice capable of integrating two or more areas of knowledge for a better performance of the actors involved in a given organizational and decision-making process, whether in the clinical or health management scope. Conclusion: Matrix support is an essential tool for the practice of managing health services and amplifying interdisciplinary actions.

Use of dental services among adults from a birth cohort in the South region of Brazil / Uso de serviços odontológicos em adultos de uma coorte de nascimentos no sul do Brasil

ABSTRACT OBJECTIVE Measure the prevalence of use of dental services in the previous year and associated factors among 31-year-old adults from a birth cohort of 1982. METHODS This is a cross-sectional study that analyzed a birth cohort of 1982 from the city of Pelotas. In 1997, a systematic sample of 27% of the city's census sectors was defined and all households in these sectors were visited, where 1,076 15-year-old adolescents were interviewed. For the oral health studies, 900 of these individuals were randomly selected and followed up at 24 and 31 years of age. The study used data collected from 523 individuals in 2013 (at 31 years old). The outcome was visit to the dentist (use of dental services) in the previous year. Demographic factors (sex), socioeconomic factors (income, education), and oral health factors (reason and type of service, self-perception of oral health, dental pain and caries experience - DMFT) were used as independent variables. Prevalence ratios were estimated using Poisson regression. RESULTS The prevalence of use of dental services in the previous year was 55.3% (95%CI: 51.0-59.5%). In the adjusted analysis, the reason and type of service, self-perception of oral health, and DMFT were associated with the outcome. A stronger association was found with use of dental services in individuals who visited for prevention and used the private service, who were satisfied with their oral health, and who had more caries experiences. CONCLUSION 55.3% of the cohort sample used dental services in the previous year. Individuals who visited the dentist of private service for preventive reasons, who were very satisfied with their oral health, used these services in a higher proportion. In addition, a higher DMFT index also led to higher use of services.

RESUMO OBJETIVO Mensurar a prevalência de uso de serviços odontológicos no último ano e os fatores associados em adultos de 31 anos pertencentes à coorte de nascimentos de 1982. MÉTODOS Estudo transversal, aninhado na coorte de nascimentos de Pelotas de 1982. Em 1997, uma amostra sistemática de 27% dos setores censitários da cidade foi realizada e todos os domicílios desses setores foram visitados, onde 1.076 adolescentes de 15 anos foram entrevistados. Para os estudos de saúde bucal foram sorteados aleatoriamente 900 desses indivíduos, que foram acompanhados também aos 24 e 31 anos. O estudo utilizou dados coletados de 523 indivíduos em 2013 (aos 31 anos). O desfecho foi a ida ao dentista (uso do serviço) no último ano. Fatores demográficos, (sexo), socioeconômicos (renda, escolaridade) e de saúde bucal (motivo e tipo de serviço da consulta, autopercepção de saúde bucal, dor e experiência de cárie - CPOD) foram utilizados como variáveis independentes. As razões de prevalência foram estimadas usando a regressão de Poisson. RESULTADOS A prevalência de uso de serviços odontológicos no último ano foi de 55,3% (IC95%: 51,0 -59,5%). Na análise ajustada, o motivo e tipo de serviço da consulta, a autopercepção de saúde bucal e o CPOD foram associados ao desfecho. Foi encontrada maior associação com a utilização de serviços odontológicos em indivíduos que visitaram por prevenção e usaram o serviço privado, satisfeitos com a sua saúde bucal e que tinham maior experiência de cárie. CONCLUSÃO 55,3% da amostra da coorte utilizaram os seviços odontológicos no último ano. Os indivíduos que visitaram o dentista por motivo preventivo, em consulta privada, que estavam muito satisfeitos ou satisfeitos com sua saúde bucal utilizaram em maior proporção esses serviços. Além disso, o maior índice de CPOD também levou ao maior uso.

Procedimentos odontopediátricos realizados pelo Sistema Único de Saúde no Rio Grande do Sul, antes e durante a pandemia de covid-19: diferença entre os anos de 2018 e 2021 / Procedimientos de odontopediatría realizados en el Sistema Único de Salud del estado de Rio Grande do Sul antes y durante la pandemia de COVID-19: diferencia entre los años 2018 y 2021 / Pediatric dentistry procedures performed within the Brazilian National Health System in the state of Rio Grande do Sul before and during the COVID-19 pandemic: difference between the years 2018 and 2021

Objective: to analyze the difference in the number of primary teeth dental procedures performed within the Brazilian National Health System (SUS) in the state of Rio Grande do Sul, before and during the COVID-19 pandemic. Methods: this was a descriptive ecological study, using secondary data from the SUS Outpatient Information System (SIA-SUS), from 2018 to 2021, in the state and in its seven health macro-regions; we calculated the relative and absolute frequencies and the percentage difference of the dental procedures performed. Results: 94,443 and 36,151 dental procedures were recorded before and during the pandemic, respectively, corresponding to a 61.7% reduction; relevant percentage reductions were found in restorative procedures, which reached 20% in the southern region of the state; an increase in the percentage of exodontic and endodontic procedures was found. Conclusion: the results suggest that the COVID-19 pandemic had negative repercussions on the performance of primary teeth dental procedures in Rio Grande do Sul.

Objetivo: analizar la diferencia en el número de procedimientos odontológicos en dentición temporal realizados en el Sistema Único de Salud del estado de Rio Grande do Sul, antes y durante la pandemia de COVID-19. Métodos: estudio ecológico descriptivo, utilizando datos secundarios del Sistema de Información Ambulatorio del SUS (SIA-SUS), de 2018 a 2021, en el estado y en las siete macrorregiones de salud. Se calcularon las frecuencias relativas, absolutas y la diferencia porcentual de los procedimientos odontológicos realizados. Resultados: se registraron 94.443 y 36.151 procedimientos odontológicos antes y durante la pandemia, respectivamente, lo que corresponde a una reducción del 61,7%. Se observaron reducciones porcentuales relevantes en los procedimientos restaurativos, que alcanzaron 20 puntos porcentuales en la región sur del estado. Se observó un aumento en el porcentaje de procedimientos de exodoncia y endodoncia. Conclusión: los resultados sugieren que la pandemia de COVID-19 tuvo repercusiones negativas en la realización de procedimientos odontológicos en dentición temporal en el estado.

Objetivo: analisar a diferença no número de procedimentos odontológicos na dentição decídua, realizados pelo Sistema Único de Saúde (SUS) no estado do Rio Grande do Sul, Brasil, antes e durante a pandemia de covid-19. Métodos: estudo ecológico descritivo, utilizando-se dados secundários do Sistema de Informações Ambulatoriais do SUS (SIA/SUS), de 2018 a 2021, no estado e em suas sete macrorregiões de saúde; foram calculadas as frequências relativas e absolutas, e a diferença percentual dos procedimentos odontológicos realizados. Resultados: foram registrados 94.443 e 36.151 procedimentos odontológicos antes e durante a pandemia, respectivamente, correspondendo a uma redução de 61,7%; reduções percentuais relevantes foram observadas nos procedimentos restauradores, atingindo 20 pontos percentuais na região Sul do estado; observou-se aumento no percentual de procedimentos exodônticos e endodônticos. Conclusão: os resultados sugerem que a pandemia de covid-19 teve repercussões negativas sobre a realização dos procedimentos odontológicos na dentição decídua, no estado.

Democratización de los servicios en salud odontológica en México / The democratization of dental health services in México

Introducción: el proceso de democratización de los servicios de odontología, y de otros campos de la salud, parte del acceso de la población a la atención y, de la libertad de contar con información científca adecuada y sufciente para cuidar la salud. De acuerdo con la constitución mexicana, es compromiso del Estado lograr contar con las condiciones políticas, económicas y sociales para el cumplimiento del mandato constitucional. Objetivo: identifcar la relación de los servicios de salud odontológica en México con el proceso de democratización. Método: se realizó una revisión bibliográfca en la base de datos BVS, en español y enfocada en la producción científca mexicana, con las siguientes palabras claves: democracia, servicios de salud y salud bucal. Conclusiones: el sistema de salud de México no ha logrado cubrir las necesidades de la población, sobre todo de aquella que es vulnerable, en tanto se requiere buena infraestructura, personal de salud, medicamentos, etc. Le corresponde al Estado impulsar iniciativas para acercar y garantizar el acceso de dicha población, sin importar lo alejada que se encuentre; apoyarse en el uso de tecnologías que faciliten esta labor y cumplir con la obligación constitucional que representa el derecho a la salud, para, con ello, democratizarlo.

Background: The process of democratization in health services in dentistry and in the entire feld of health starts from the access of the population to care, from the freedom to have adequate and sufcient scientifc information for the population to take care of their health. According to the Constitution, the State is committed to providing the political, economic and social conditions for the fulflment of the constitutional mandate. Objective: Identify the relationship between dental health services in Mexico and the democratization process. Method: A bibliographic review was carried out in the VHL database with the keywords "democracy", "health services" "oral health" focused on Mexico and in Spanish language. Conclusions: The health system in Mexico has not been able to meet the needs of the population, especially those who are vulnerable; good infrastructure, health personnel, medicines, etc. are required. It is up to the state to promote initiatives to provide access to this population, no matter how far away they are, and to support the use of technologies that facilitate and allow the constitutional obligation to fulfl the right to health and thus democratize health.

Systemic and oral health status of older adult inpatients in an intensive care unit / Avaliação da condição sistêmica e oral de idosos internados em uma unidade de terapia intensiva

Objective: To assess the systemic and oral health status of geriatric patients hospitalized in an intensive care unit (ICU). Methods: A cross-sectional descriptive study of a convenience sample of 78 older ICU inpatients. A single calibrated examiner collected demographic and clinical data by analyzing patients' records and assessing their oral cavities. Descriptive data analysis was performed to a 5.00% significance level. All patients provided informed consent and were conscious during the oral health assessment. Results: The mean age was 77.69 years and 51.28% of the sample were male. The main reasons patients were admitted to the ICU investigated were postoperative conditions (23.08%) and cardiac abnormalities (20.51%). Systemic arterial hypertension (69.23%) was the most prevalent comorbidity and patients were being treated with anticoagulants (57.69%) and antimicrobials (53.85%). Most patients did not receive oral care (64.10%), while 29.49% of them received it only once, and 57.69% were denture users. The mean decayed, missing, and filled teeth index was 23.74 (17.44 missing teeth, on average) and majorities had tongue biofilm (71.79%) and unsatisfactory oral hygiene during their time in hospital (84.62%). Conclusion: The oral status of hospitalized geriatric patients was characterized by poor hygiene and edentulism

Objetivos: Avaliar o estado de saúde sistêmica e oral de pacientes geriátricos internados em uma unidade de terapia intensiva (UTI). Metodologia: Estudo transversal descritivo, com amostra de conveniência de 78 idosos internados na UTI. Um único examinador calibrado coletou dados demográficos e clínicos, analisando os registros dos pacientes e avaliando as suas cavidades orais. A análise descritiva dos dados foi realizada com nível de significância de 5,00%. Todos os pacientes forneceram consentimento informado e estavam conscientes durante a avaliação da saúde oral. Resultados: A média de idade foi de 77,69 anos e 51,28% da amostra era do sexo masculino. Os principais motivos de internação dos pacientes na UTI investigados foram condições pósoperatórias (23,08%) e alterações cardíacas (20,51%). A hipertensão arterial sistêmica (69,23%) foi a comorbidade mais prevalente, e os pacientes estavam sendo tratados com anticoagulantes (57,69%) e antimicrobianos (53,85%). A maioria dos pacientes não recebeu cuidados orais (64,10%), enquanto 29,49% deles os receberam apenas uma vez e 57,69% eram usuários de próteses dentárias. O índice médio de dentes cariados, perdidos e obturados foi de 23,74 (17,44 dentes ausentes, em média) e a maioria apresentou biofilme lingual (71,79%) e higiene oral insatisfatória durante a internação (84,62%). Conclusão: A condição oral dos pacientes geriátricos hospitalizados foi caracterizada por má higiene e edentulismo.

Oral health care of homebound older adults: multidimensional theoretical model / Cuidado à saúde bucal de idosos domiciliados: modelo teórico multidimensional

OBJECTIVES: To understand the dimensions of oral health care of homebound older adults and to develop a preliminary theoretical model that explains how these dimensions are interrelated in the provision of care. METHODS: Cross-sectional, qualitative study, based on Grounded Theory. Participants were 37 intentionally selected older adults registered at a Primary Health Care center, Florianópolis (SC), Brazil. Data collection was conducted at home, following an interview script. The interviews were audio-recorded, transcribed, and analyzed by constant comparison. Formulation of the model followed the Glaserian approach. RESULTS: The theoretical model presents the dimensions of oral health care of homebound older adults - who, why, when, how, and where oral health care is provided. Frailties were identified in all dimensions of oral health care, with emphasis on those related to older adults' living, health, and oral health conditions, compromising dental care provided at home, access to dental services, and presence of the dentist. In combination, these frailties constitute a rupture in the possibilities for oral health care. CONCLUSIONS: Strategies for provision of oral health care to homebound older adults should be implemented in each of the dimensions to overcome the frailties identified and promote better oral health conditions and access to dental services. (AU)

OBJETIVOS: Compreender quais as dimensões presentes no cuidado à saúde bucal de idosos domiciliados e elaborar um modelo teórico preliminar que explique de que modo essas dimensões estão inter-relacionadas na produção do cuidado. METODOLOGIA: Estudo transversal, qualitativo, com referencial da Teoria Fundamentada nos Dados. Participaram 37 idosos, intencionalmente selecionados, cadastrados na Atenção Primária à Saúde, Florianópolis (SC). A coleta de dados foi realizada no domicílio, seguindo roteiro de entrevista. As falas foram gravadas em áudio, transcritas e analisadas por comparação constante. A elaboração do modelo seguiu a vertente glaseriana do método. RESULTADOS: Identificaram-se fragilidades no processo de cuidado em todos os elementos de caracterização (quem, porque, quando, como e onde), destacando-se as relacionadas ao próprio idoso, a sua condição de saúde bucal, ao cuidado realizado no domicílio, ao acesso aos serviços odontológicos e à participação do cirurgião-dentista. O somatório dessas fragilidades promove uma ruptura nas possibilidades de cuidado à saúde bucal nas múltiplas dimensões: individual, familiar, profissional e institucional. CONCLUSÕES: Estratégias de cuidado à saúde bucal prestado aos idosos em domicílio devem ser implementadas em cada uma das dimensões identificadas a fim de superar as fragilidades e promover melhores condições de saúde bucal e acesso aos serviços odontológicos. (AU)