Characteristics and in-hospital morbidity trends associated with oral and oropharyngeal cancers in Brazil.

BACKGROUND: Brazil experienced an expansion of the population's access to oral health policies after the creation of the Unified Health System (SUS, Sistema Único de Saúde). Through public policies, the consolidation of Primary Health Care (PHC) and the incorporation of dental care into primary and hospital care took place. The objective of this study was to identify epidemiological aspects, including the temporal trend, of hospital morbidity from oral and oropharyngeal cancer in Brazil, considering hospitalizations for this neoplasm in a hospital network linked to the public care system. METHODS: Observational study based on information on hospital admissions for oral cancer throughout Brazil. The research used data from the Brazilian Cancer Registry Information System. For the temporal series analysis, generalized linear regression model was used with the Prais-Winsten method. RESULTS: Of the 121,971 patients hospitalized with oral and oropharyngeal cancers, 76.40% were male and 23.60% were female, resulting in a M:F ratio of 3.24:1. Regarding the anatomical region of involvement among hospitalized patients with oral cavity neoplastic lesions, there was a predominance in non-specific places in the mouth, such as the floor of the mouth, soft and hard palate, among others (32.68%), followed by lesions in the region of tongue (28.89%). In this population, the predominant age group was between the fifth decade (31.09%) and sixth decade of life (24.99%); men presented neoplastic lesions of oral and oropharyngeal cancers at an earlier age than women. In all regions of the country, the staging of cases diagnosed in the tertiary health network accredited to the José Alencar Gomes da Silva National Cancer Institute (INCA) was late, with higher tendency for metastasis. The temporal trend of the adjusted in-hospital morbidity rates showed to be increasing in the Northeast, South and Midwest regions for the male gender. For females, they were increasing in the Northeast and South regions. CONCLUSIONS: It is concluded that the distribution of in-hospital morbidity rates of oral and oropharyngeal cancers in the country is irregular. There is a greater number of cases identified by the study in male patients and in the Southeast and South regions; with an increasing tendency of this coefficient in both genders.

Attributes of primary health care in Mato Grosso do Sul state: PCAT-Brazil paired for users and health professionals, 2018.

OBJECTIVE: The objective of the present study was to analyse the quality of adults and older adults health care in Primary Health Care (PHC) services in the State of Mato Grosso do Sul, 2018. METHODS: A quantitative survey was carried out in which the municipalities participating in the study included the four macro-regions following the Director Regional Plan (DRP). In this study, the quality of care was verified using the validated version of the PCAT-Br for adult and older adults users over 18 years of age and professionals. The professional's and users' views were compared between PHC attributes in the State of Mato Grosso do Sul. We performed the paired student t-test. STATA v.14.2 software (College Station, TX, USA) was used for the analyses. Sensitivity analysis was done to compare socio-demographic characteristics. RESULTS: Eight hundred twenty-five users and 424 professionals participated in the study. According to users, the Accessibility attribute had the worst performance in all macro-regions (mean score PCAT = 3.58). There were significant differences between the perception of users and professionals (PCAT = 5.32 for users and PCAT = 7.11 for professionals) in all attributes evaluated. CONCLUSIONS: There was a difference in users' and professionals' perceptions between PHC attributes. Therefore, it is necessary to strengthen PHC care networks in the State, mainly considering the users' perspectives.

Inclusion of oral health teams in primary health care promotes early diagnosis of oral and oropharyngeal cancers: a nationwide study.

BACKGROUND: Oral and oropharyngeal cancers are considered important public health problems worldwide. This study aims to analyze the association between late diagnosis of oral and oropharyngeal cancers in Brazil and the contextual indicators of socioeconomic variables and coverage of Primary Health Care (PHC), and to assess the temporal trend of late diagnosis. METHODS: In this cross-sectional observational study, secondary data were evaluated with a time series analysis. All Brazilian cities that reported at least one case of oral and oropharyngeal cancers each year in the period between 2000 and 2013 were included; and the staging was analyzed by calculating the ratio risk for late diagnosis for each municipality. The association between staging and socioeconomic variables and offer of PHC was calculated using multiple linear regression. The time trend of the risk ratio for late-stage diagnosis was calculated using the Prais-Winsten method. RESULTS: One hundred and sixty Brazilian municipalities had at least one annual case of oral and oropharyngeal cancers notified to the INCA hospital system between 2000 and 2013. The adjusted model showed that the higher the Gini value (greater social inequality) and the lower the HDI value (less human development) was, the higher was the number of tumors diagnosed at a late stage, considering the size of the tumor. A greater risk for late diagnosis was identified, as early as at the stage of lymph node involvement, when there was a higher level of social inequality and lower level of coverage by Oral Health Teams (OHT) in PHC. The greater the social inequality, the greater was the risk of late diagnosis, as early as in the stage of metastasis. CONCLUSIONS: We concluded that, during the evaluated period, there was an increase in the number of cases diagnosed at the most advanced stage. Furthermore, there was association between higher levels of social inequality and an increase in the proportion of late diagnosis of oral and oropharyngeal cancers. In addition, the inclusion of Oral Health Teams in Primary Health Care promoted the early diagnosis of these types of cancers.

Impact of continuing education on maternal and child health indicators.

OBJECTIVE: This study investigated whether the presence of care workers who completed a specialization course on family health was associated with improved care and maternal and child health indicators in municipalities in the state of Mato Grosso do Sul, Brazil. METHODS: Negative binomial regression models with fixed effects were used for the 79 municipalities in the state of Mato Grosso do Sul, with repeated observations for the period 2009-2015. For our reference, the parameter "number of professionals who completed the course" calculated the proportion of professionals who completed the course, and was divided by the total number of primary health care professionals in the municipality to create a ratio. The cutoff points used represented tertile distribution: T3: high (0.35-1.00), T2: intermediate (0.02-0.33) and T1: low (0.00-0.01); to avoid biased results, the analysis was also performed for the years prior to the beginning of the course in question (2009 and 2010). RESULTS: During the study period, enrollment of pregnant women, exclusive breastfeeding for children under 4 months, and up-to-date vaccinations in children younger than 1 year to 23 months increased (high to intermediate categories) in municipalities where professionals who completed the specialization course worked. Growth in the intermediate ratio was also observed in indicators related to cervical cancer screening and new diagnoses of congenital syphilis in infants under one year of age. CONCLUSIONS: The presence of care workers who completed a specialization course on family health was seen to be associated with improved care and indicators for maternal and child health in municipalities in the state of Mato Grosso do Sul, Brazil. These findings reaffirm the importance and effectiveness of policies on training and continuing education for the Brazilian Unified Health System.

Integração ensino-serviço-comunidade, metodologias ativas e Sistema Único de Saúde: percepções de estudantes de Odontologia / Teaching-service-community integration, active methodologies and Unified Health System: perceptions of Dentistry students

Resumo Introdução O modelo tradicional de formação em saúde hegemônico e tecnicista limita as respostas às demandas atuais do Sistema Único de Saúde (SUS). Para superar essas fragilidades, a integração ensino-serviço-comunidade (IESC) e as metodologias ativas (MAs) se apresentam como estratégias de reorientação da formação profissional. Objetivo Este estudo analisou as percepções de estudantes de Odontologia da Universidade Federal de Mato Grosso do Sul (UFMS) acerca das práticas pedagógicas à luz das MAs e da IESC no e para o SUS. Método Trata-se de pesquisa qualitativa, realizada entre 2012 e 2013, com 73 estudantes que estavam matriculados e cursando a disciplina de Estágio Obrigatório de Odontologia em Saúde Coletiva II (EOOSC II). O convite para participar da pesquisa foi feito após o encerramento da disciplina, quando as notas já haviam sido lançadas. Utilizou-se de um roteiro contendo questões norteadoras, que versavam sobre a opinião dos estudantes acerca: (1) da disciplina; (2) das potencialidades e fragilidades da metodologia de ensino-aprendizagem utilizada e das unidades de saúde frequentadas; e (3) da intenção de, após a formatura, trabalhar no SUS/Estratégia Saúde da Família. Após a coleta, os dados foram transcritos, e, na sequência, foi processado o discurso do sujeito coletivo (DSC). Resultados A IESC, articulada com as MAs, propiciou aos estudantes conectar teoria e prática, integrada à realidade do SUS. Conclusão Os participantes da pesquisa relataram a relevância da educação permanente em saúde e as dificuldades/potencialidades da utilização de MAs integradas à IESC na formação profissional, apontando o SUS como real possibilidade de trabalho ao se formarem.

Abstract Background The traditional model of hegemonic and technicist health training limits the answers to the current demands of the Unified Health System (USH). To overcome these weaknesses, Teaching-Service-Community Integration (TSCI) and Active Methodologies (AM) are presented as strategies for reorienting vocational training. Objective This study analyzed the perceptions of dentistry students of Federal University of Mato Grosso do Sul (UFMS), related to pedagogical practices in light of AM and TSCI for and in the USH. Method It was a qualitative research, which was carried out between 2012 and 2013, with 73 students, who were enrolled and attending the Compulsory Internship in Collective Health Dentistry II (CICHD II). The invitation was made after the course end, when the grades had already been released. A script was used containing guiding questions, which dealt with students' opinions about: (1) the course; (2) the potentialities and weaknesses of the teaching-learning methodology used and the Health Units attended; And (3) the intention to, after graduation, work in the USH /Family Health Strategy. After the data collection, they were transcribed and, subsequently, the Collective Subject Discourse (CSD) was processed. Results The TSCI, which was articulated to the AM, allowed students to connect theory and practice, integrated to the realities of USH. Conclusion They noted the relevance of the permanent education in health and the difficulties/potentialities of using active methodologies integrated to the TSCI in the professional formation, pointing the UHS as a real possibility of work when they will be graduate.

Impact of distance education on primary health care indicators in central Brazil: An ecological study with time trend analysis.

OBJECTIVE: The objective of this study was to verify whether the inclusion of professionals who completed a specialized distance learning course in family health teams is associated with rates of hospitalization for primary healthcare-sensitive conditions and better monitoring of chronic conditions in municipalities within the state of Mato Grosso do Sul, Brazil. METHODS: Negative binomial regression models with fixed effects were used for the 79 municipalities in the state, with repeated observations for the selected years (2009-2015). For our reference, the parameter "Municipality Ratio" was the number of professionals who completed the course divided by the total number of PHC professionals in the municipality. This ratio has been cumulative over the years. No reference values were found in the scientific literature, so three cutoff points were used for tertile distribution: T3:high (0.35-1.00), T2:intermediate (0.02-0.33), and T1:Low (0.00-0.01). In order to avoid capturing biased results, the analysis was also performed for the years before the specialization course was offered (2009 and 2010). RESULTS: Indicators of the share of hospitalizations for primary care-sensitive conditions (overall rate and specific rates for asthma, gastroenteritis, and heart failure) decreased during the study period when related to a high and intermediate proportion of professionals who completed the specialization course, and the same was seen for indicators of chronic conditions (diabetic and hypertensive patients) who were registered, monitored and group care. CONCLUSION: The specialization course impacted important indicators related to the attributions of primary health care professionals, considering that decreases in hospitalizations for primary care sensitive causes (overall rate of sensitive causes, specific rates for asthma, gastroenteritis and heart failure) were seen in the territories where professionals who completed this course worked, along with increased registration and monitoring of diabetic and hypertensive patients.

Influence of Photodynamic Therapy in the Control of Postoperative Pain in Endodontic Treatment: A Cross-Sectional Randomized Clinical Trial

Objective: To evaluate the postoperative pain at different times after endodontic treatment with and without the use of photodynamic therapy (PDT) of asymptomatic teeth with apical periodontitis. Material and Methods: In this cross-sectional randomized clinical trial, the treatment was performed in a single visit with and without the use of photodynamic therapy. The sample consisted of 10 patients with two teeth in the same jaw, but on different sides (splitmouth), subjected to the same endodontic treatment with reciprocating instrumentation in the apical foramen instrumentation limit. The teeth from each patient were randomly divided into two groups: G1 (Control): endodontic treatment without photodynamic therapy and G2 (PDT): received methylene blue 0.005% and irradiation with a low-level laser. The fillings were performed with a Touch'n Heat technical device and Ah Plus sealer. The treatments of G1 and G2 in the same patient were performed in an interval of 3 weeks between them and the blinding study was ensured during all long treatment. Postoperative pain was recorded using an adapted VAS scale in times of 6, 12, 24, 36, 48, and 72 hours. Results: In both groups, the highest value recorded at the VAS scale was 2 mm (no pain), and there were no statistically significant differences in postoperative pain between the groups at any observation times (p<0.05). Conclusion: The photodynamic therapy did not have advantages to control postoperative pain in endodontic treatments of asymptomatic teeth with apical periodontitis, since both groups showed low levels of pain in all patients evaluated.

Factors associated with a fantastic lifestyle in Brazilian college students - a multilevel analysis / Fatores associados ao estilo de vida fantástico de universitários brasileiros - uma análise multinível

ABSTRACT Purpose: to analyze possible associations between a Fantastic lifestyle and self-perception of oral health, binge drinking, and socio-demographic variables among public college students. Methods: questionnaires validated for use in Brazil were applied to 672 students in randomly selected courses. It was the first questionnaire to assess a Fantastic lifestyle, the second to measure oral health-related quality of life (OHIP-14), and the third to include socio-demographic information. Multilevel linear regression was used for the analyses. Results: among the participants, 64.21% were full-time students, 52.82% were females, 50.85% had a family income between 4 and 8 minimum wages, 16.75% were binge drinkers, and 22.22% used to drive after drinking. Socio-demographic variables such as income (p = 0.001), religion (p = 0.02), marital status (p = 0.021), binge drinking (p <0.001), and OHIP-14 (p <0.001) were associated with a Fantastic lifestyle. Conclusions: fantastic lifestyle of the Brazilian college students was associated with income, oral health-related quality of life, marital status, religion, and alcohol consumption (binge drinking).

RESUMO Objetivo: analisar associações entre o estilo de vida fantástico com a auto percepção de saúde bucal, a prática de Binge-drinking e variáveis sócio demográficas de universitários. Métodos: foram aplicados três questionários validados, sendo o primeiro questionário, para medir o estilo de vida fantástico, o segundo, para medir a qualidade de vida em saúde bucal (Ohip-14) e um terceiro com informações sociodemográficas, e aplicados em 672 estudantes. Foram realizadas regressões lineares multiníveis para analisar as associações. Resultados: verificou-se que 64,21% eram do turno integral, 52,82% do gênero feminino, 50,85% tinham renda familiar entre 4 a 8 salários mínimos, 16,75% praticam Binge-drinking e que 22,22% dirigem após beber. As variáveis sociodemográficas renda (p=0,001), ser praticante de religião (p=0,02), estado conjugal (p=0,021), Binge-drinking (p<0,001) e escore Ohip-14 (p<0,001) estiveram significativamente associados ao estilo de vida fantástico. Conclusão: o estilo de vida fantástico de universitários brasileiros esteve associado à renda, à qualidade de vida em saúde bucal, à situação conjugal, à pratica religiosa e ao consumo de álcool (Binge-drinking).

Temperature Changes on External Root Surfaces with the Use of Several Thermoplastic Filling Techniques.

INTRODUCTION: The purpose of this study was to measure the temperature rise on the external root surface of filled root canals using Touch'n Heat (Analytic Endodontics, Orange, CA), the TC System (TC; Tanaka de Castro & Minatel Ltda, Cascavel, PR, Brazil), and the Tagger technique. METHODS: Forty-five single-canal mandibular premolar human teeth were used in the 3 experimental groups. The root canals were enlarged to accommodate up to an R40 Reciproc file (VDW, Munich, Germany). Next, the specimens were filled according to the technique evaluated. The measurement of the temperature was performed by K chromium-aluminum thermocouples attached to the coronal, middle, and apical root levels. RESULTS: There was a significant difference among the 3 techniques (P < .001) in relation to the temperature variation between the highest temperature and the initial temperature. The highest temperature change was found with the Tagger technique at the middle third root level (11.8°C), and the lowest variation was in TC at the cervical third (2.05°C). CONCLUSIONS: There was a rise of temperature on the external root surface for all of the techniques evaluated. TC showed the lowest temperature rise.

Análise comparativa entre selante resinoso e selante ionomérico por microscópio eletrônico de varredura / Comparative analysis between resin sealant and ionomer by scanning electron microscope

O selamento de superfícies oclusais como procedimento efetivo na prevenção de cárie, desde o seu reconhecimento pela ADA em 1976, vem sendo utilizado como método preventivo, seguro e eficaz.

The sealing of occlusal surfaces as an effective procedure in the prevention of dental caries, its recognition since 1976 by ADA, has been used as a preventive, safe and effective method.

Avaliação de técnicas de obturação para canais instrumentados pelo Sistema Reciproc© / Evaluation of filling techniques for canals instrumented with the Reciproc© System

Objetivo: Investigar se a modelagem do sistema Reciproc interfere na realizaçÆo da técnica Sistema (TC) e compará-las com outras duas técnicas: Cone énico sistema Reciproc (CU) e McspaddenModificada(MC), quanto à porcentagem da área preenchida por gutapercha,cimento Ahplus e áreas vazias, no terço apical em canais instrumentados pelo sistema Reciproc©. Metodologia: Quinze raízes mesiais de molares inferiores foram instrumentadas por instrumento único recíproco R25 e separadas nosgrupos: CU, TC e MC. Após as obturaçães os dentes foram seccionadosnos níveis de 2mm e 4mm do forame e imagens foram obtidas para medir a porcentagem da área do canal obturada com os materiais obturadores e os espaços vazios, sendo os dados submetidos ao teste estatístico de Kruskal-Wallis. Resultados: Comparando-se as técnicas sem distinçÆo dos níveis, verificou-se que, para o preenchimento Guta Percha, TC se diferenciou de CU e de MC, apresentando média maior que ambas. Para o Cimento, novamente as diferenças surgiram entre TC e as outras duas, mas com TC apresentando média menor que elas. Com relaçÆo à µrea Vazia nÆo foi encontrada diferença estatisticamente significativa entre TC, CU e MC. Conclusães: A modelagem proporcionada pela lima R25 do SistemaReciproc nÆo interfere no emprego da técnica TC. O preenchimento com Guta Percha apresentou maior media na técnica TC, em conseqüência, o Cimento apresentou a menor média, ambos comdiferenças significantes para MC e CU. Com relaçÆo à µrea Vazia o comportamento foi igual para todas as técnicas...

Objective: To investigate whether the shaping promoted by the Reciproc© system interferes with performing the System technique (TC) in comparison with two other techniques - Single Cone Reciproc© system (CU) and Modified Mcspadden (MC) -, relative to the percentage of the area filled by gutta-percha and Ahplus sealer and non-filled areas in the apical third of canals instrumented with the Reciproc© system. Methods: Fifteen mesial roots of mandibular molars were instrumented by a single reciprocate R25 file and assigned to three groups: CU, TC and MC. After root filling, the teeth were sectioned at 2 and 4 mm short of the apical foramen. Images were captured to calculate the percentages of canal area occupied by and free of filling material. Data were analyzed statistically by the Kruskal-Wallis test. Results: Comparison of the techniques regardless of apical levels revealed that for gutta-percha filling, TC presented significantly greater means than CU and MC. For the sealer, TC presented significantly lower means than CU and MC. Regarding the area free of filling material, no statistically significant difference was found among TC, CU and MC. Conclusions: Canal shaping produced by the Reciproc© system?s R25 file does not interfere with the use of the TC technique. Gutta-percha filling presented the greatest mean value with the TC technique and sealer filling presented the lowest mean value, both with significant differences from MC and CU. Regarding the empty area (no filling), the same outcome was observed for all techniques...

Própolis como agente terapêutico alternativo para o controle do biofilme dentário / Propolis as alternative therapeutic agent for the dental biofilm's control

Historicamente, a própolis foi utilizada como medicamento por suas propriedades químicas. A partir dos anos 80, vários estudos demonstraram sua capacidade antimicrobiana, permitindo, assim, seu emprego terapêutico e preventivo. Esse artigo tem como objetivo demonstrar, através de revisão da literatura, a relevância da utilização da própolis no campo da Cariologia, considerando o seu caráter determinante para a estabilização dos fatores microbianos e de equilíbrio do processo de desmineralização e remineralização (processo DES-RE) da estrutura dentária. A própolis demonstrou ser efetiva na inibição da enzima glicosiltransferase (GTF), bem como na diminuição da produção de polissacarídeos insolúveis ou glucanos, que interferem na adesão bacteriana e, consequentemente, permeiam o acúmulo/estagnação do biofilme cariogênico. Estudos realizados in vivo e in vitro demonstraram que a presença de flavonoides na composição química da própolis comprova sua ação antibacteriana, e sugerem o seu emprego no controle do biofilme bacteriano bucal. Esse estudo permitiu concluir que, por apresentar comprovada ação antimicrobiana, a própolis representa um potencial agente de controle da cárie dentária, do acúmulo do biofilme cariogênico e do processo DES-RE. Entretanto, em relação ao processo DES-RE, sugerem-se novos estudos para obtenção de dados mais consistentes.

In vivo comparison of the biocompatibility of two root canal sealers implanted into the subcutaneous connective tissue of rats.

OBJECTIVE: To evaluate the subcutaneous biocompatibility of 2 root canal sealers. STUDY DESIGN: The subcutaneous implant technique recommended by the Fédération Dentaire International (FDI) was used to test Endométhasone and EndoREZ root canal sealers. These materials were placed in Teflon tubes, 1 mm in diameter and 10 mm in length, and implanted into 2 pockets created in the back of 40 Calomys callosus rodents, 20 for each material. Tissue biopsies were collected and histologically examined 15, 30, 60, and 90 days after the implantation procedure. The overall level of the inflammatory tissue response was graded as none, slight, moderate, or severe on the sealer-connective tissue interface at the opening ends of the tubes. The connective tissue response along the lateral wall outside of each tube served as a negative control. RESULTS: The tissue reaction to the Endométhasone diminished with time. The EndoREZ sealer was highly toxic during all experimental periods. CONCLUSION: Endométhasone root canal sealer presented biocompatibility within the analyzed periods, whereas EndoREZ showed no biocompatible behavior and caused late hypersensitive reaction.