Orthodontics in the oral health care network of the Unified Health System (SUS).

This observational study aimed to describe and analyze data from two external evaluations of the National Program for Improving Access to and Quality of Dental Specialty Centers (PMAQ CEO), held in 2014 and 2018 in Brazil, which evaluated Dental Specialty Centers (CEO) using a national and census approach. We selected questions through a search in the microdata of the first and second evaluations. The groups were analyzed independently. To compare the groups, nonparametric tests were performed (Mann Whitney U). The formulated hypotheses were: there would be no differences between the data of these groups (h0) and there would be differences between the data of these groups (h1). For qualitative nominal variables, frequency distribution was verified and association tests were performed (chi-square test). The significance level for this study was set at 5%. We observed that orthodontic treatments were found in about 13% of the CEO. Regarding human resources, most professionals were specialists or had MSc or PhD degrees; were civil servants; had been hired by direct administration; or had been hired via public tender. Regarding the work process and inclusion of the CEO in the health care network, we observed a greater number of services that use single and electronic medical records, greater presence of services monitoring and analyzing goals, greater knowledge about monthly average of absenteeism (for 2018); and larger number of services with referrals from primary health care centers (for 2014). Expanding the view on orthodontics and including preventive, interceptive, and corrective treatments at different points in health care networks are essential strategies for achieving comprehensive care in universal health systems.

Orthodontics in the oral health care network of the Unified Health System (SUS)

Abstract This observational study aimed to describe and analyze data from two external evaluations of the National Program for Improving Access to and Quality of Dental Specialty Centers (PMAQ CEO), held in 2014 and 2018 in Brazil, which evaluated Dental Specialty Centers (CEO) using a national and census approach. We selected questions through a search in the microdata of the first and second evaluations. The groups were analyzed independently. To compare the groups, nonparametric tests were performed (Mann Whitney U). The formulated hypotheses were: there would be no differences between the data of these groups (h0) and there would be differences between the data of these groups (h1). For qualitative nominal variables, frequency distribution was verified and association tests were performed (chi-square test). The significance level for this study was set at 5%. We observed that orthodontic treatments were found in about 13% of the CEO. Regarding human resources, most professionals were specialists or had MSc or PhD degrees; were civil servants; had been hired by direct administration; or had been hired via public tender. Regarding the work process and inclusion of the CEO in the health care network, we observed a greater number of services that use single and electronic medical records, greater presence of services monitoring and analyzing goals, greater knowledge about monthly average of absenteeism (for 2018); and larger number of services with referrals from primary health care centers (for 2014). Expanding the view on orthodontics and including preventive, interceptive, and corrective treatments at different points in health care networks are essential strategies for achieving comprehensive care in universal health systems.

Análise das urgências odontológicas durante a pandemia da covid-19 / Analysis of dental emergencies during the COVID-19 pandemic

Aim: to analyze, between 2019-2021, the quantitative changes in dental emergencies (DE) in Brazil and its regions. Materials and Methods: Data collected in the Primary Care Health Information System (SISAB) from 2019 to 2021. The DE represented by dentoalveolar abscess (DAA) and toothache (TA). 2019 was the control (non-pandemic), and 2020-21 the exposure year. Durbin-Conover's Friedman and Post-Hoc tests used a significance level of 5%. The data's organization used the percentage difference to facilitate analysis. Results: For Brazil in 2021, the percentage difference with 2019 suggests that DAA (-2.16%, p=1.0) and TA (+14.94%, p=0.064) returned to values after fall of 2020. The South region, in 2020, had no decrease in DAA (-5.48%, p=0.436) and TA (+3.7%, p<0.001) in 2020, and an increase in both in 2021 (DAA: +26.86%, p<0.001; TA: +51.06%, p<0.001). Discussion: In 2021, in Brazil, limited elective access and resumption of DAA and increase in TA suggest worsening the oral health and quality of life. The DAA and TA results in the South region do not provide plausible evidence to understand the unchanged values in 2020 and the considerable increase in 2021. Conclusion: Regardless of the pandemic, elective access still struggles to offer universal acessing, equitable, and the need of investments are essentials to prevent public services from becoming just gateways for relieving pain and suffering.

Objetivo: analisar, entre 2019-2021, as alterações quantitativas nas urgências odontológicas (UO) no Brasil e suas regiões. Materiais e Métodos: Dados coletados no Sistema de Informação em Saúde da Atenção Básica (SISAB) no período de 2019 a 2021. A representação das UO foi pelo abscesso dento-alveolar (ADA) e dor de dente (DD). O ano de 2019 foi o ano de controle (não pandêmico) e 2020-21 os de exposição. Os testes Friedman e Post-Hoc de Durbin-Conover utilizaram nível de significância de 5%. Os dados foram organizados pela diferença percentual para facilitar a análise. Resultados: Para o Brasil em 2021, a diferença percentual com 2019 sugerem que o ADA (-2,16%, p=1,0) e a DD (+14,94%, p=0,064) retomaram os valores, após a queda de 2020. A região Sul, em 2020, não teve queda em ADA (-5,48%, p=0,436) e DD (+3,7%, p<0,001) em 2020, e aumento em ambos em 2021 (ADA: +26,86%, p<0,001; DD: +51,06%, p<0,001). Discussão: Em 2021, no Brasil, o limitado acesso eletivo e a retomada da ADA e aumento da DD sugerem piora na saúde bucal e na qualidade de vida. Os resultados de ADA e DD na região Sul não apresentam evidências plausíveis para compreender a inalteração de valores em 2020 e o considerável aumento em 2021. Conclusão: Independentemente a pandemia, o acesso eletivo ainda luta para ser universal, equânime e os investimentos precisam ser retomados para evitar que os serviços públicos se tornem em apenas portas de entrada de alívio dor e sofrimento.

Geographic Distribution of Brazilian Dentists: Motivation and Perception for Migration / Distribuição Geográfica dos Dentistas Brasileiros: Motivação e Percepção para a Migração

The Human Resources for Health (HRH) are considered as being crucial for the organization of the health systems and for the population health conditions; in this context, the purpose of this work is 1) to identify the current geographic distribution situation of Brazilian dentists, 2) to identify and analyze the perception and motivations of Brazilian dentists who migrated to the interior of the country. A case study approach was used and the data were collected from different sources (Federal Council of Dentistry, Health Graduation Indicators System, Geocapes, Brazilian National Institute of Geography and Statistics) using the mixed method, from the quantitative-qualitative exploratory sequential model, the qualitative phase was analyzed by using the "grounded theory" approach. The findings point out that the county has a great stock of dentists and that it significantly increased in recent years; however, it is poorly distributed over the territory, particularly when the differences between the interior and the capitals of the country are analyzed. The main category of the grounded theory was "The opportunities changing the ways to consolidate the professional"; the interviews point out that the dentists' place of birth and the opportunities over their professional career were crucial to determine the distribution of dentists throughout the Brazilian territory. It's concluded that Brazil has a dentistry workforce stock; however, it faces the results of the lack of HRH regulation policies which include dentistry. Such reality enhances the health gaps in some country regions and market saturation in major urban centers.(AU)

Os Recursos Humanos em Saúde (RHS) são considerados fundamentais para a organização dos sistemas de saúde e para as condições de saúde de uma população, nesse contexto o objetivo desse trabalho é 1) identificar a situação atual da distribuição geográfica de dentistas brasileiros 2) identificar e analisar a percepção e motivações de dentistas brasileiros que migraram para o interior do país. Foi utilizada a abordagem de estudo de caso e os dados foram coletados a partir de diferentes fontes (Conselho Federal de Odontologia, Sistema de Indicadores das Graduações em Saúde, Geocapes, Instituto Brasileiro de Geografia e Estatística), utilizando o método misto, a partir do modelo exploratório sequencial quantitativo-qualitativo, a fase qualitativa foi analisada por meio da abordagem da "teoria fundamentada". Os achados apontam que o país apresenta um grande estoque de dentista, e que houve uma grande expansão nos últimos anos, no entanto este apresenta-se mal distribuídos pelo território, principalmente quando analisado as diferenças entre o interior e as capitais do país. A categoria central da teoria fundamentada foi "As oportunidades mudando os caminhos para consolidar o profissional", as entrevistas apontam que o local de nascimento dos dentistas e as oportunidades durante sua trajetória profissional foram decisivas para determinar a distribuição de dentistas no território brasileiro. Conclui-se, que o Brasil apresenta estoque de força de trabalho em odontologia, porém enfrenta os resultados da falta de políticas de regulação de RHS, que inclua a odontologia. Essa realidade acentua os vazios sanitários em algumas regiões do país e saturação do mercado nos grandes centros.(AU)

Household food insecurity, dental caries and oral-health-related quality of life in Brazilian Indigenous adults.

Food insecurity is a complex phenomenon that affects the health and wellbeing of vulnerable families. The aim of this study was to investigate the relationship between household food insecurity, dental caries, oral health-related quality of life, and social determinants of health among Indigenous adults. A cross-sectional study was conducted among Kaingang adults aged 35-44 years old from the Guarita Indigenous Land, Brazil. Food insecurity was assessed through the EBIA scale. Dental caries was assessed using the DMFT index. Participants answered the OHIP-14 questionnaire and a structured interview. Descriptive and multivariate analyzes using Poisson regression models were performed. The final sample included 107 adults from 97 households. Approximately 95% lived in food insecure families. Severe food insecurity was present in 58% of the households. The phenomenon was associated to the Bolsa Família benefit, household size, and greater perception of oral health impacts on quality of life. The high number of families affected by food insecurity reveals the social vulnerability of the Kaingang people. Food insecurity in Kaingangs adults is associated to oral health perception and social determinants of health.

Sedentary behavior, unhealthy food consumption and dental caries in 12-year-old schoolchildren: a population-based study.

This study analyzed the association between sedentary behavior (SB), unhealthy food consumption, and dental caries amongst 12-year-old schoolchildren. An epidemiological survey was carried out in the five largest cities (> 80,000 inhabitants) of the State of Mato Grosso do Sul, Brazil. Data were collected on decayed, missing and filled teeth index (DMFT), sociodemographic characteristics, SB, unhealthy food consumption, and water fluoridation status. The analysis was based on the theoretical framework established by J Sisson. Structural equation models were performed to test the association of dental caries experience with sociodemographic, contextual, and behavioral factors. The mean DMFT index in the five cities was 1.02 (95%CI: 0.39-1.66). Higher sedentary behavior (more than 2 hours/day) [standardized coefficient (SC) = 0.21 95%CI: 0.07-0.39] and higher unhealthy food consumption (more than 4 times/week) [SC = 0.23 (0.10-0.45)] were associated with higher DMFT index than their counterparts. Also, cities with fluoridated water were associated with lower DMFT index [SC = -0.85 (-1.20--0.50)]. Families who had a per capita income above the poverty line had a direct association with unhealthy food consumption [SC = -0.24 (-0.38--0.11)]. Unhealthy food consumption mediated the association of sedentary behavior on DMFT index [SC=0.07 (0.02-0.13)]. Sensitivity analysis confirmed the findings. Sedentary behavior mediated by unhealthy food consumption had a significant association with dental caries experience. Public policies must address transdisciplinary actions to reduce sedentary behavior and unhealthy food consumption and promote water fluoridation.

Household food insecurity, dental caries and oral-health-related quality of life in Brazilian Indigenous adults / Insegurança alimentar domiciliar, cárie dentária e qualidade de vida relacionada à saúde bucal em Indígenas adultos brasileiros

Abstract Food insecurity is a complex phenomenon that affects the health and wellbeing of vulnerable families. The aim of this study was to investigate the relationship between household food insecurity, dental caries, oral health-related quality of life, and social determinants of health among Indigenous adults. A cross-sectional study was conducted among Kaingang adults aged 35-44 years old from the Guarita Indigenous Land, Brazil. Food insecurity was assessed through the EBIA scale. Dental caries was assessed using the DMFT index. Participants answered the OHIP-14 questionnaire and a structured interview. Descriptive and multivariate analyzes using Poisson regression models were performed. The final sample included 107 adults from 97 households. Approximately 95% lived in food insecure families. Severe food insecurity was present in 58% of the households. The phenomenon was associated to the Bolsa Família benefit, household size, and greater perception of oral health impacts on quality of life. The high number of families affected by food insecurity reveals the social vulnerability of the Kaingang people. Food insecurity in Kaingangs adults is associated to oral health perception and social determinants of health.

Resumo Insegurança alimentar é um fenômeno complexo que afeta a saúde e o bem-estar de famílias vulneráveis. Este estudo objetivou investigar a relação entre insegurança alimentar domiciliar, cárie dentária, qualidade de vida relacionada à saúde bucal, e determinantes sociais de saúde entre indígenas adultos. Foi conduzido um estudo transversal com adultos Kaingang entre 35-44 anos da Terra Indígena Guarita, Brasil. Insegurança alimentar foi avaliada pela escala EBIA. Cárie dentária foi avaliada pelo índice CPOD. Participantes responderam o questionário OHIP-14 e uma entrevista estruturada. Foram realizadas análises descritivas e multivariadas usando modelos de regressão de Poisson. A amostra incluiu 107 adultos Kaingang de 97 domicílios. Aproximadamente 95% dos participantes viviam em famílias com insegurança alimentar. Insegurança alimentar grave esteve presente em 58% dos domicílios. O fenômeno foi associado ao Bolsa Família, densidade familiar e percepção dos impactos da saúde bucal na qualidade de vida. O alto número de famílias afetadas pela insegurança alimentar revela a vulnerabilidade social do povo Kaingang. Insegurança alimentar em adultos Kaingang está associada à percepção da saúde bucal e determinantes sociais da saúde.

Association between Oral Health Literacy and Socioeconomic Variables in Users of Centers for Dental Specialties

ABSTRACT Objective: To test possible associations between Oral Health Literacy (OHL) level and socioeconomic covariates among users of Centers for Dental Specialties (CEOs). Material and Methods: The Health Literacy in Dentistry (HeLD-14) instrument was applied to 130 adult users of CEOs located in 13 municipalities in the state of São Paulo - Brazil, as well as socioeconomic issues. The researcher applied instruments in a specific room after randomly selecting individuals in the waiting room and invitation acceptance. Each item was ranked on a 5-point scale, ranging from 0 to 4, in which high scores indicate minimal difficulties in performing functions (high OHL) and low scores indicate very limited abilities to perform functions (low OHL). Statistical analysis using the Levene test was used to verify the possibility of using the one-way ANOVA test, and in case results show positive values (p>0.05), the Kruskal Wallis test was used. Results: The average age of participants was 45 years, with more than half being female (68.7%) with 9-11 years of schooling (48.4%). When considering the total value of HeLD-14 questions, OHL was associated with covariates schooling, marital status and family income. Conclusion: OHL levels were associated with socioeconomic variables, contributing to evidence in this field of specialized care.

Admission of dentist in Brazilian Universal Health System (SUS): a priority agenda for the strengthening of Smiling Brazil. / Mecanismos de ingresso de dentistas no SUS: uma agenda prioritária para o fortalecimento do Brasil Sorridente.

This article aims at: i) describing and analyzing the expansion of dental care in the Unified Health System (SUS); ii) Identifying and analyzing the characteristics of hiring dentists' in the public service; iii) characterizing public vacancies, their duties and remuneration. In this descriptive case study, databases of the Ministry of Health were consulted and public tender notices. The findings indicate that 48% of the dentists enrolled in the National Registry of Health Establishments (CNES) perform care in the SUS, in 13 years there was an increase of 118% of the municipalities with oral health teams (eSB) implanted. The population coverage estimated by eSB increased by 10.46% between the years 2007 and 2015. The main mechanism for joining the Dental Specialties Centers (CEO) was the public tender. Primary care salaries ranged from 1.05 to 12.67 Brazilian minimum wages, to 40-hour weekly jobs, and to CEOs from 3.35 to 7.05. It is concluded that, among other measures, the planning of HRH strategies is necessary. The continuity of successes regulatory measures of labor contracts and support to local managers enter the agenda of priority actions of oral health policy.

Este artigo objetiva i) descrever e analisar a expansão do provimento de dentistas no Sistema Único de Saúde (SUS); ii) identificar e analisar as características do vínculo trabalhista dos dentistas com o serviço; iii) caracterizar as vagas em concurso público, no que se refere aos requisitos, atribuições e remuneração. Neste estudo de caso, descritivo, foram consultados bancos de dados do Ministério da Saúde e editais de concurso público. Os achados apontam que 48% dos dentistas cadastrados no Cadastro Nacional dos Estabelecimentos de Saúde (CNES) realizam atendimento no SUS, em 13 anos observou-se um aumento de 118% dos municípios com equipes de saúde bucal (eSB) implantadas. A cobertura populacional estimada pelas eSB aumentou 10,46% entre os anos de 2007 e 2015. O principal mecanismo de ingresso nos Centros de Especialidades Odontológicas (CEO) foi o concurso público. O salário na atenção primária variou de 1,05 a 12,67 salários mínimos, para cargos de 40 horas semanais e nos CEOs de 3,35 a 7,05. Conclui-se que é necessário, entre outras medidas, o planejamento de estratégias voltadas aos recursos humanos em saúde. A continuidade dos êxitos alcançados demanda que medidas regulatórias dos contratos de trabalho e apoio aos gestores entrem na agenda das ações da política em saúde bucal.

Mecanismos de ingresso de dentistas no SUS: uma agenda prioritária para o fortalecimento do Brasil Sorridente / Admission of dentist in Brazilian Universal Health System (SUS): a priority agenda for the strengthening of Smiling Brazil

Resumo Este artigo objetiva i) descrever e analisar a expansão do provimento de dentistas no Sistema Único de Saúde (SUS); ii) identificar e analisar as características do vínculo trabalhista dos dentistas com o serviço; iii) caracterizar as vagas em concurso público, no que se refere aos requisitos, atribuições e remuneração. Neste estudo de caso, descritivo, foram consultados bancos de dados do Ministério da Saúde e editais de concurso público. Os achados apontam que 48% dos dentistas cadastrados no Cadastro Nacional dos Estabelecimentos de Saúde (CNES) realizam atendimento no SUS, em 13 anos observou-se um aumento de 118% dos municípios com equipes de saúde bucal (eSB) implantadas. A cobertura populacional estimada pelas eSB aumentou 10,46% entre os anos de 2007 e 2015. O principal mecanismo de ingresso nos Centros de Especialidades Odontológicas (CEO) foi o concurso público. O salário na atenção primária variou de 1,05 a 12,67 salários mínimos, para cargos de 40 horas semanais e nos CEOs de 3,35 a 7,05. Conclui-se que é necessário, entre outras medidas, o planejamento de estratégias voltadas aos recursos humanos em saúde. A continuidade dos êxitos alcançados demanda que medidas regulatórias dos contratos de trabalho e apoio aos gestores entrem na agenda das ações da política em saúde bucal.

Abstract This article aims at: i) describing and analyzing the expansion of dental care in the Unified Health System (SUS); ii) Identifying and analyzing the characteristics of hiring dentists' in the public service; iii) characterizing public vacancies, their duties and remuneration. In this descriptive case study, databases of the Ministry of Health were consulted and public tender notices. The findings indicate that 48% of the dentists enrolled in the National Registry of Health Establishments (CNES) perform care in the SUS, in 13 years there was an increase of 118% of the municipalities with oral health teams (eSB) implanted. The population coverage estimated by eSB increased by 10.46% between the years 2007 and 2015. The main mechanism for joining the Dental Specialties Centers (CEO) was the public tender. Primary care salaries ranged from 1.05 to 12.67 Brazilian minimum wages, to 40-hour weekly jobs, and to CEOs from 3.35 to 7.05. It is concluded that, among other measures, the planning of HRH strategies is necessary. The continuity of successes regulatory measures of labor contracts and support to local managers enter the agenda of priority actions of oral health policy.

Da fragmentação à formação interprofissional: proposta de um modelo de estágio curricular supervisionado para a graduação em odontologia / From fragmentation to interprofessional training: proposal of a current model of supervised curricular stage for graduation in dentistry

Objetiva-se apresentar uma proposta de Estágio Curricular Supervisionado (ECS) para os cursos de graduação em odontologia, no sentido de viabilizar uma Educação Interprofissional em serviços de Atenção Primária à Saúde (APS). Trata-se de estudo qualitativo, dividido em duas etapas. Na primeira, dois sujeitos realizaram a observação participante das clínicas de uma Unidade Básica de Saúde com um olhar direcionado para o potencial pedagógico da inserção interprofissional. As impressões e reflexões foram registradas em diários de pesquisa e os pesquisadores foram entrevistados individualmente. Na segunda etapa, 21 alunos de graduação em odontologia, 03 profissionais e 03 gestores de serviços públicos, que recebem alunos de graduação, foram entrevistados. O material coletado foi analisado pela triangulação de dados e pela hermenêutica-dialética. O recorte apresentado nesse trabalho descreve e analisa a experiência da imersão interprofissional (observação participante) e, após triangular o material coletado por meio de entrevistas e diários de pesquisa, apresenta uma proposta de ECS para os cursos de graduação em odontologia. Os resultados evidenciaram o potencial pedagógico da vivência interprofissional que permitiu maior compreensão da inter-relação das diversas clínicas com a saúde bucal e revelou elementos para construção do ECS. O modelo de ECS elaborado organiza-se de modo a permitir a Educação Interprofissional, a compreensão do processo saúde-doença, a integralidade da atenção e os aspectos inerentes à clínica ampliada de saúde. Acredita- se que esse modelo reverte-se de força para inquietar o instituído e fomentar processos de reorientação dos currículos de odontologia direcionados para o fortalecimento do Sistema Único de Saúde.

The objective of this study is to present a proposal for a Supervised Curricular Internship (SCI) for dentistry undergraduate courses in order to enable an Interprofessional Education in Primary Health Care (PHC) services. It is a qualitative study, divided into two stages. In the first one, two subjects performed the participant observation of the clinics of a Basic Health Unit with a directed look at the pedagogical potential of interprofessional insertion. Impressions and reflections were recorded in research journals and the researchers were interviewed individually. In the second stage, 21 undergraduate students in dentistry, 03 professionals and 03 managers of public services, who receive undergraduate students, were interviewed. The material collected was analyzed by data triangulation and hermeneutic-dialectic. The clipping presented in this paper describes and analyzes the experience of interprofessional immersion (participant observation) and, after triangular the material collected through interviews and research journals, presents a proposal of SCI for undergraduate courses in dentistry. The results evidenced the pedagogical potential of the interprofessional experience that allowed a better understanding of the interrelationship of the various clinics with oral health and revealed elements for the construction of SCI. The SCI model elaborated is organized to allow interprofessional education, an understanding of the health-disease process, the integrality of attention and the aspects inherent in the expanded health clinic. It is believed that this model reverses itself of force to disturb the instituted and foment processes of reorientation of the curricula of dentistry directed towards the strengthening of Health Unic System.

Oral Cancer Screening in Elderly in Sao Paulo State, Brazil (2001 to 2009)

Objective: To describe and explore analytically the trends of oral cancer positive cases incidence during nine-year screenings campaign of Sao Paulo´s State (Brazil) and to show other countries and health services an option for tracking at-risk population. Material and Methods: Secondary official data were tabulated and analysed using the Excel and STATA statistical 10.0 software packages. After descriptive statistics, the trend curves were calculated by moving average for each variable (type moving average of two samples centred) to attenuate the random variability of the series, and trends classified: stable, ascending and descending. Results: The trend of municipalities numbers remained stable; the number of examined people, the screening coverage and the absolute number of patients referred to secondary health care showed an increasing trend; and the percentage of suspected cases showed a decreasing trend during the nineyear period. A decrease in the number of suspicious lesions and confirmed cases of oral cancer among the volunteers was observed, and the reorganization of secondary and tertiary levels of oral care helped to modify these numbers. Conclusion: We believe this experience was more important to help health services organization than for the oral cancer diagnosis itself, and it might be used to inspire other countries and oral health services.

A clínica do corpo sem boca / The clinic of the body without a mouth

Resumo Este estudo buscou analisar a abordagem do território bucal feita por profissionais e estudantes da área médica durante consultas clínicas em uma Unidade Básica de Saúde, do município de São Paulo, e pode ser classificado como uma pesquisa de abordagem qualitativa, em que os dados foram derivados da observação participante das atividades clínicas de médicos e estudantes de medicina em uma Unidade Básica de Saúde do município de São Paulo. Os dados foram coletados por duas pesquisadoras, ao longo de quatro meses de imersão, e analisados por hermenêutica-dialética. Foi possível compreender a propedêutica clínica na área médica e perceber a centralidade de tecnologias-duras e 'prescrições' na abordagem clínica, em detrimento da centralidade do sujeito. Além disso, estudantes de medicina demonstraram desconhecimento da organização do serviço, revelando um descompasso entre formação e trabalho. Nas diferentes clínicas, mesmo quando havia inspeção da cavidade bucal, não houve o estabelecimento de conexões entre achados e sintomas apresentados pelos pacientes. A 'experienciação' das clínicas na Unidade Básica revelou a visão centrada no que "sobra do corpo" ao retirar a boca. Ou seja, a desconexão corpo-boca é reforçada também na área médica.

Abstract The aim of this study was to analyze oral's territory approach by professionals and students from medical area during clinical appointments at a Health Basic Center, in São Paulo. This paper can be qualified as a qualitative research, in which the data collected were issued from the observation of doctors and students' activities over four months of immersion, and were analyzed by hermeneutics-dialectics. It was possible to see that clinical propaedeutic in the medical area and the guide of hard-technologies and the 'prescriptions' in clinical approach, rather than the centrality of the subject. In addition, medical students demonstrated lack of knowledge of the service organization, revealing a gap between education and work. In different clinics, even when there was an examination of the oral cavity, connections between finds and symptoms presented by patients were not established. The experience of clinics in the Health Center showed the focus on what "the body left over" when the mouth was removed. Thus, the body-mouth disconnection is reinforced in the medical area.

Educação pelo trabalho: reorientando a formação de profissionais da saúde / Education through work: reshaping the education of health professionals / Educación por medio del trabajo: reorientación de la formación de profesionales de salud

O trabalho se propôs a avaliar o Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) instituído na Universidade de São Paulo, Brasil. Os sujeitos do estudo foram preceptores e alunos de odontologia que integraram a proposta entre os anos de 2009 e 2012. Foi utilizada uma abordagem qualitativa, sendo os dados coletados por grupos focais e analisados por análise de conteúdo temática. Os resultados evidenciam que a educação pelo trabalho é capaz de auxiliar no processo formativo, ampliar o olhar do estudante em direção ao processo saúde/doença e despertar para atuação futura no âmbito do Sistema Único de Saúde (SUS). Uma das vantagens apontadas consiste no estabelecimento da interdisciplinaridade no processo formador. Os resultados do estudo traduzem o programa como um poderoso instrumento de indução de mudanças nas concepções dos profissionais de saúde...

This study aimed to evaluate the Education through Work for Health Program (“PET-Saúde”) that had been instituted at the University of Sao Paulo, Brazil. The subjects were dentistry preceptors and students who took part in the proposal between the years 2009 and 2012. A qualitative approach was used, in which data were gathered through focus groups and evaluated through thematic content analysis. The results show that education through work is capable of assisting in the education process, through expanding students’ perceptions of the health/disease process and raising awareness regarding future actions within the sphere of the Brazilian Health System. One of the advantages is the establishment of interdisciplinarity in the education process. The results indicate that the program is a powerful instrument for inducing changes in the concepts among healthcare professionals...

Se propuso la evaluación del Programa de Educación por Medio de Trabajo para la Salud (PET-Saúde) instituido en la Universidad de São Paulo, Brasil. Los sujetos fueron preceptores y alumnos de odontología que integraron la propuesta entre los años 2009 y 2013. Se utilizó un abordaje cualitativo, siendo los datos colectados por grupos focales y analizados por análisis de contenido temático. Los resultados mostran que la educación por medio del trabajo es capaz de auxiliar en el proceso formativo, ampliar la mirada del estudiante en dirección al proceso salud/enfermedad y despertar para la actuación futura en el ámbito del Sistema Brasileño de Salud. Una de las ventajas consiste en el establecimiento de la interdisciplinariedad en el proceso formador. Los resultados traducen el programa como un poderoso instrumento de inducción de cambios en las concepciónes de los profesionales de salud...

Conditional factors for untreated caries in 12-year-old children in the city of São Paulo.

The aim of the study was to analyze what sociodemographic and economic variables were associated with the presence of untreated caries in 12-year-old children in the city of São Paulo. This cross-sectional study had a complex sample design. It was based on secondary data generated by the Levantamento epidemiológico em saúde bucal (Epidemiological Oral Health Survey) in the city of São Paulo, conducted in 2008, whose sample comprised 4,246 12-year-old children from the public and private schools of all the administrative districts of the city. A questionnaire was applied and an epidemiological exam was performed in accordance with the World Health Organization's (WHO) recommendations. The variables of interest were categorized into a dependent variable of untreated dental caries (carious component of the DMFT index that corresponds to carious, missing and filled teeth) and independent variables related to the socioeconomic and demographic conditions of the children and their families, and to their access to dental services. The EPI-INFO 06 and STATA 10 programs were used for the analysis; the prevalence ratio and a confidence interval of 95% were applied to the population parameters. The Poisson regression model was used, adjusted for sampling of the complex type. Caries was associated with ethnicity (higher rate in black people, p=0.042), attending public school (p=0.000), lower average family income (p=0.002), overcrowded dwellings (p=0.000) and presence of pain (p=0.000). Caries is a multifactorial disease influenced by social health determinants that intensify its risk.

Conditional factors for untreated caries in 12-year-old children in the city of Sao Paulo

The aim of the study was to analyze what sociodemographic and economic variables were associated with the presence of untreated caries in 12-year-old children in the city of São Paulo. This cross-sectional study had a complex sample design. It was based on secondary data generated by the Levantamento epidemiológico em saúde bucal (Epidemiological Oral Health Survey) in the city of São Paulo, conducted in 2008, whose sample comprised 4,246 12-year-old children from the public and private schools of all the administrative districts of the city. A questionnaire was applied and an epidemiological exam was performed in accordance with the World Health Organization's (WHO) recommendations. The variables of interest were categorized into a dependent variable of untreated dental caries (carious component of the DMFT index that corresponds to carious, missing and filled teeth) and independent variables related to the socioeconomic and demographic conditions of the children and their families, and to their access to dental services. The EPI-INFO 06 and STATA 10 programs were used for the analysis; the prevalence ratio and a confidence interval of 95% were applied to the population parameters. The Poisson regression model was used, adjusted for sampling of the complex type. Caries was associated with ethnicity (higher rate in black people, p = 0.042), attending public school (p = 0.000), lower average family income (p = 0.002), overcrowded dwellings (p = 0.000) and presence of pain (p = 0.000). Caries is a multifactorial disease influenced by social health determinants that intensify its risk.

Interferência da saúde bucal em funçães biológicas e sociais segundo a percepçÆo de adolescentes brasileiros / Perception of brazilian adolescents about the influence of oral health on biological and social functions

Objetivo: Analisar a interferência da saúde bucal em funçães biológicas e sociais, segundo a percepçÆo de adolescentes brasileiros de 15 a 19 anos. Método: Estudo transversal a partir do banco de dados do levantamento epidemiológico do Brasil 2003õ (n=16.112). O banco foi recategorizado, tendo como variáveis dependentes a percepção em relação à saúde bucal e como esta é classificada; a aparência; se há interferência na mastigação; influência na fala e o quanto a saúde bucal interfere nos relacionamentos pessoais. Realizaram-se associações bivariada e multi variada entre variáveis sociodemográficas e de condiçÆo de saúde bucal com o desfecho relacionado às funções biológicas (mastigação e fala) e sociais (aparência e relaçães pessoais). Utilizou-se o modelo de regressão de Poisson, ajustado pela amostragem do tipo complexa, sendo o município sorteado a Unidade Primária de Amostragem. Empregou-se a RazÆo de Prevalência com IC 95%. Resultados: A mastigaçÆo foi considerada péssima ou ruim entre negros e pardos (RP=1,31), com má oclusÆo (RP=1,52), doença periodontal (RP=1,33), necessidade de exodontia (RP=1,59) e dor (RP=3,92). A fala pior ou ruim foi associada a jovens com dentes ausentes (RP=1,42), má oclusÆo (RP=2,14), necessidade de exodontia (RP=1,32) e dor (RP=3,27). A pior aparência foi identificada por negros e pardos (RP=1,20), com dentes ausentes (RP=1,19), má oclusÆo (RP=1,52), doença periodontal (RP=1,56), cárie dentária (RP=1,49), necessidade de exodontia (RP=1,54) e dor (RP=2,12). A saúde bucal afetou os relacionamentos pessoais de negros e pardos (RP=1,20), com dentes ausentes (RP=1,37), má oclusÆo (RP=1,27), necessidade de exodontia (RP=1,24) e dor (RP=1,80). Conclusão: Condiçães desfavoráveis de saúde bucal e de caracterizaçÆo sociodemográfica tiveram reflexos negativos nas percepçães de saúde bucal e influenciaram a qualidade de vida dos adolescentes brasileiros...

Objective: To assess the influence of oral health on biological and social functions as perceived by Brazilian adolescents aged 15 to 19 years. Method: This investigation was a cross-sectional study based on the data from the epidemiological database ?SB Brasil 2003? (n=16,112). The database was re-categorized using as dependent variables perception of oral health and how it its classified; personal appearance; possible influence on mastication; influence on the speach; and how much oral health influences on the personal relationships. Bivariate and multivariate associations were performed among the sociodemographic and oral health condition variables with the endpoint relative to biological (speech and mastication) and social (personal appearance and interpersonal relationships) functions. Poisson?s regression model adjusted by complex type sampling was used, with the city chosen by lottery being the Primary Sampling Unit. Prevalence ratio was used with 95% confidence interval. Results: Mastication was considered very bad and bad among blacks and mulattos (PR=1.31) with malocclusion (PR=1.52), periodontal disease (PR=1.33), need of extraction (PR=1.59) and pain (PR=3.92). The worst or bad speech was associated with young people with missing teeth (PR=1.42) malocclusion (PR =2.14), need of extraction (PR=1.32) and pain (PR =3.27). The worst personal appearance was reported by blacks and mulattos (RP=1.20) with missing teeth (PR=1.19), malocclusion (PR =1.52), periodontal disease (PR =1.56), dental caries (PR =1.49), need of extraction (RP=1.54) and pain (RP=2.12). Oral health influenced the personal relationships of blacks and mulattos (RP=1.20) with missing teeth (RP=1.37), malocclusion (RP=1.27), need of extraction (RP=1.24) and pain (RP=1.80). Conclusion: Unfavorable oral health conditions and sociodemographic characteristics had negative impacts on the oral health perceptions and influenced the Brazilian adolescents' quality of life...

Práticas para a saúde: avaliação subjetiva de adolescentes / Practices for health: subjective evaluation of adolescents

Este trabalho verificou as percepções sobre a satisfação com a vida, o corpo e a saúde de adolescentes, cujas práticas se refletem na saúde bucal. Por meio de pesquisa qualitativa, jovens de Barueri/São Paulo foram entrevistados pela técnica do grupo focal. Seus discursos foram analisados pela análise de conteúdo. Os resultados indicam que a alimentação desses jovens é pouco balanceada; o cuidado com o corpo é sinônimo de banho e esportes, e a saúde bucal foi limitada à escovação; recorrem ao convênio pela demora do atendimento no posto de saúde. O conhecimento da percepção dos jovens sobre esses eixos pode contribuir para o aprimoramento das ações e do acesso aos meios de prevenção, tratamento e manutenção da saúde bucal.

This study assessed the perceptions of satisfaction with life, body and health of adolescents, whose practices are reflected in oral health. Through qualitative research, adolescents in the city of Barueri/São Paulo were interviewed by the focus group technique. Their discourses were analyzed using content analysis. The results reveal that those young people have a poorly balanced feeding; the care of the body is seen as synonymous with bathing and sports and oral hygiene care was limited to brushing; many reported use of the services of dental plan due to the delays in health care units. Knowing the perception of young people on these axes can contribute to the improvement of the shares and access to means of prevention, treatment and maintenance of oral health.

Reorganization of secondary and tertiary health care levels: impact on the outcomes of oral cancer screening in the São Paulo State, Brazil.

This study presents the strategies for prevention and early detection of oral cancer by means of screening in the elderly population of São Paulo, the richest and the most populous state of Brazil. This research was a retrospective longitudinal study based on the analysis of secondary data. The variables - number of participating cities, coverage of screening, and number of suspicious and confirmed cases of oral cancer - were divided into two periods: 2001-2004 and 2005-2008. Data were analyzed statistically by the chi-square test at 5% significance level. The implementation of a nationwide public oral health policy in 2004 and the reorganization of the secondary and tertiary health care were evaluated as mediator factors able to interfere in the achieved outcomes. From 2001 to 2008, 2,229,273 oral examinations were performed. There was an addition of 205 participating cities by the end of the studied period (p<0.0001). The coverage of oral cancer screening increased from 4.1% to 16% (p<0.0001). There was a decrease in the number of suspicious lesions (from 9% in 2005 to 5% in 2008) (p<0.0001) and in the rate of confirmed oral cancer cases per 100,000 examinations (from 20.89 in 2001 to 10.40 in 2008) (p<0.0001). After 8 years of screening, there was a decrease in the number of suspicious lesions and confirmed cases of oral cancer in the population. The reorganization of secondary and tertiary health care levels of oral care seems to have contributed to modify these numbers, having a positive impact on the outcomes of oral cancer screening in the São Paulo State.

A teoria na prática: proposta de curriculum frente às diretrizes curriculares nacionais do curso de graduação em Odontologia / Theory in practice: curriculum proposal in front of the national curriculum guidelines for graduation courses in dentistry

Introdução: o ensino superior brasileiro em Odontologia apresenta duas realidades distintas: o aluno que se intenta formar e aquele que efetivamente se forma. Essa dualidade ocorre pelas necessidades do mercado, pelos interesses comerciais das universidades privadas e outros fatores, enquanto as Diretrizes Curriculares Nacionais do Curso de Graduação em Odontologia apontam em outra direção. Objetivo: explanar sobre as diretrizes curriculares nacionais do curso de graduação em Odontologia mostrando as disciplinas e propostas do curso. Metodologia: a explanação sobre as diretrizes e as propostas será dada por meio da comparação da resolução CNE/CES, de 19 de fevereiro de 2002, com o projeto pedagógico da Universidade de São Paulo, São Paulo, SP, Brasil. A escolha desta faculdades e deu pela sua tradição, pelo número de docentes com linhas de pesquisa que se destacam no cenário odontológico nacional, e, por ser uma universidade pública situada em um centro reconhecidamente de maior poder econômico. Conclusão: o projeto apresentado mostra-se adequado quando comparado com a resolução do Conselho Nacional de Educação.

Introduction: higher education in Brazil in Dentistry presents two distinct realities: the student who intends to form and one that effectively builds. This duality occurs by market needs, the commercial interests of private universities and other factors such as the National Curriculum Guidelines for Undergraduate Dental point in another direction. Aim: this paper seeks to explain about the national curriculum guidelines for the graduation course in Dentistry shown their disciplines and proposals for the graduation course in Dentistry. Methodology: the explanation of the guidelines and proposals will be given by comparing the Resolution CNE/CES, of 19 February 2002, with the pedagogical dental school in Brazil, the University of São Paulo, São Paulo, SP, Brazil. The choice of this option is given by tradition, by the number of professors, with research areas that stand out in the dental setting and being a national public university located in a recognized center of greater economic power. Conclusion: the project presented is appropriate when compared to the National Education Council resolution.