Processo de aprendizagem colaborativa entre residentes e estudantes de graduação em Odontologia em um hospital universitário de Curitiba / Collaborative learning process between residents and undergraduate Dentistry students at a university hospital in Curitiba

Com o reconhecimento do exercício da Odontologia Hospitalar e sua aprovação como uma nova especialidade pelo Conselho Federal de Odontologia em 2023, e validação das novas Diretrizes Curriculares Nacionais para o Curso de Odontologia homologadas em 2021, os cursos de graduação em Odontologia no Brasil tendem a qualificar futuros profissionais em formação para atuar em ambiente hospitalar, de forma sistematizada. Isso visa propiciar aosestudantes uma vivência interprofissional inerente aos hospitais, favorecendo a interação positiva entre várias áreas da saúde. Este estudo descritivo tem como objetivo relatar a experiência no processo de aprendizagem colaborativa entre profissionais de saúde residentes do Programa de Residência Multiprofissional em Saúde do Idoso, na área profissional de Odontologia, de um Hospital Universitário de Curitiba e estudantes de graduação do curso de Odontologia de uma instituição de ensino superior. Durante odesenvolvimento de diferentes atividades acadêmicas, observou-se que a utilização desta metodologia de ensino-aprendizagem caracterizou-se como uma ferramenta importante, buscando fortalecer as trocas de vivências práticas, propiciando discussões entre estudantes e profissionais residentes, por meio da mediação dos docentes, os quais buscavam sempre incentivar a construção do conhecimento crítico reflexivo, oportunizando uma experiência de formação discente interprofissional ampliada (AU).

Con el reconocimiento de la práctica de la Odontología Hospitalaria y su aprobación como nueva especialidad por el Consejo Federal de Odontología en 2023, y la validación de las nuevas Directrices Curriculares Nacionales para la Carrera de Odontología aprobadas en 2021, las carreras de pregrado en Odontología en Brasil tienden a capacitar a los futuros profesionales en formación para trabajar en el entorno hospitalario, de forma sistemática. Se pretende proporcionar a los estudiantes una experienciainterprofesional inherente a los hospitales, favoreciendo la interacción positiva entre las diversas áreas de la salud. Este estudio descriptivo tiene como objetivo relatar la experiencia en el proceso de aprendizaje colaborativo entre profesionales de lasalud residentes en el Programa de Residencia Multidisciplinaria en Salud del Adulto Mayor, en el área profesional de Odontología, en un Hospital Universitario de Curitiba y estudiantes de pregrado de la carrera de Odontología en Curitiba de una institución de educación superior. Durante el desarrollo de diferentes actividades académicas, se observó que el uso de esta metodología de enseñanza-aprendizaje se caracterizó como una herramienta importante, buscando fortalecer el intercambio de experiencias prácticas, promoviendo el debate entre estudiantes y profesionales residentes, a través de la mediación de los docentes. que siempre buscó incentivar la construcción de conocimientos reflexivos críticos, brindando una experiencia ampliada de formación interprofesional de los estudiantes (AU).

With the recognition of the Hospital Dentistry practice,its approval as a new specialty by the Federal Dental Council in 2023 and validation of the new National Curricular Guidelines for the Dentistry Course approved in 2021, undergraduate Dentistry courses in Brazil tend to qualify future professionals in training to work in a hospital environment, in a systematic manner. This aims to provide students with an interprofessional experience inherent to hospitals, favoring the positive interaction between various health specialties. This descriptive study reportsthe experience in the collaborative learning process between health professionals residentsof the Multiprofessional Residency Program in Elderly Health in the professional area of Dentistry at a University Hospital in Curitiba,and undergraduate Dentistry students from a higher education institutionin Curitiba. During the development of different academic activities, it was observed that the use of this teaching-learning methodology was characterized as an important tool, seeking to strengthen the exchange of practical experiences, promoting discussions betweenstudents and resident professionals, by the mediation of professors, who always encourage the construction of critical reflective knowledge, providing an expanded interprofessional student training experience (AU).

Legislation in Hospital Dentistry: Gaps, Perspectives and Desires

Abstract Objective: To analyze the existing state legislation, including not only the ordinary laws, but also their infralegal regulation and the state legislation on Hospital Dentistry. Material and Methods: A survey was carried out in the databases of the Legislative Assemblies of the Brazilian States and the Federal District, as well as the Regional and Federal Councils of Dentistry in Brazil. Subsequently, a survey was carried out in the databases of the Ministry of Health, State Dental Councils and Federal Dental Council in Brazil. Results: Only 8 Brazilian states have legislation in force regarding hospital dentistry, which represents 29.63% of the federative units. Among the Brazilian regions, the Midwest presented the highest prevalence of the laws found (37.50%), followed by the North (25%) and the other regions with the same coverage (12.50%). Also, an orientation and an ordinance from the Ministry of Health, six resolutions from the Federal Council of Dentistry, and a technical note from the National Health Surveillance Agency were found. Conclusion: Several States do not have rules on the subject, making it imperative to create a federal rule that not only imposes the presence of the dentist, but also regulates the proportion of the team, workload, and availability.

Hospital dental staff attitudes to guide education and training in patient safety: a study with a focus on qualitative data.

Objectives This study aimed to determine attitudes of current NHS dental hospital trainees at dental core trainee and speciality registrar level, plus consultant trainers, to guide shaping the direction of education and training in patient safety. The study was a locally based project in a single dental hospital setting at an acute NHS London Trust.Methods This study employed a survey and interviews, with emphasis on qualitative data utilised. Interviews were aimed at hospital clinical dental staff. The survey and focus groups were aimed at trainees. The one-on-one interview sessions were aimed at trainers.Results Findings demonstrated that both trainers and trainees see patient safety as a priority and there are gaps in education and training. Four overarching themes were seen as important to trainees and trainers to support education and training in patient safety: culture, knowledge, time to train and engagement.Conclusions Recommendations in this dental hospital setting focused on culture change and dental-specific experiential learning based on spiral curricula. Education and training in patient safety should be introduced at undergraduate level, with regular team training acknowledging the need for consistent engagement of all key stakeholders.

Odontologia hospitalar no ambiente digital: o que se pública sobre esta habilitação? / Hospital dentistry in the digital environment: what is published about this qualification?

Objetivo: O objetivo deste trabalho foi caracterizar as publicações sobre odontologia hospitalar disponíveis em páginas da internet e em páginas do Instagram, além de avaliar a qualidade dos conteúdos disponíveis do ponto de vista da evidência científica e do uso de referências. Métodos: Foi realizado um estudo transversal e exploratório. A partir da pesquisa da chave de busca "odontologia hospitalar" foram localizadas páginas do Instagram e da Internet via Google. Resultados: No Instagram foram localizadas 15 páginas que atendiam aos critérios de inclusão, e as últimas 5 publicações foram analisadas (n=75). Para o Google foram avaliados conteúdos que correspondessem à projeto de lei, entre os primeiros 25 resultados da pesquisa, já que se trata dos mais relevantes a partir da marcação do algoritmo. Percebeu-se que o uso de referências não é frequente nem nas publicações do Instagram, tampouco nos conteúdos da Internet. Tal fato é tão importante, que os resultados deste trabalho demonstram essa urgência na mudança de cenário dos conteúdos publicados na rede mundial de computadores. Conclusão: Nesse sentido, os professores e os próprios conselhos podem atuar como bússolas, na orientação da divulgação e consumo de conteúdo aos estudantes e aos profissionais de saúde.(AU)

Aim: The objective of this study was to characterize the publications on hospital dentistry available on websites and Instagram pages, in addition to evaluating the quality of the available content from the point of view of scientific evidence and the use of references. Methods: A cross-sectional and exploratory study was carried out. From the research of the search key "hospital dentistry", Instagram and Internet pages were located via Google. Results: On Instagram, 15 pages that met the inclusion criteria were located, and the last 5 publications were analyzed (n=75). For Google, content that corresponded to the bill was evaluated, among the first 25 search results, since these are the most relevant based on the algorithm's marking. It was noticed that the use of references is not frequent either in Instagram publications or in Internet content. This fact is so important that the results of this work demonstrate this urgency in changing the scenario of content published on the World Wide Web. Conclusion: In this sense, professors and the councils themselves can act as compasses, guiding the dissemination and consumption of content to students and health professionals. (AU)

Manifestações bucais em pacientes internados na UTI de um hospital público / Oral manifestations in patients admitted to the ICU of a Public Hospital

Introdução: durante a permanência em Unidades de Terapia Intensiva (UTIs), os pacientes internados apresentam maior vulnerabilidade a alterações na cavidade oral decorrentes do uso de equipamentos de respiração artificial e do estado imunocomprometido em que se encontram. Objetivo: identificar as principais manifestações bucais em pacientes internados em uma UTI bem como verificar o conhecimento dos profissionais responsáveis pela higienização bucal. Metodologia: trata-se de um estudo quantitativo descritivo com delineamento transversal. Os dados foram obtidos nos prontuários médicos dos pacientes e através de um exame clínico intraoral. Para os profissionais responsáveis pela higiene bucal, foi utilizado um questionário. As análises foram realizadas no programa SPSS versão 21.0 de forma descritiva. Resultados: as manifestações bucais com maior incidência foram saburra lingual, biofilme dentário, candidíase, devido a qualidade da higiene bucal prestada e a baixa imunidade. Os achados bucais e sistêmicos relacionados aos pacientes com maior tempo de internação foram ressecamento labial, queilite angular, língua despapilada, candidíase e pneumonia. Todos os profissionais responsáveis pela higienização bucal dos pacientes tinham formação técnica em enfermagem e desconheciam alterações importantes como biofilme dentário e pneumonia nosocomial. Conclusão: os dados deste estudo permitem concluir que apesar da constância com que é realizada a higienização bucal, verifica-se alta frequência de lesões bucais nos pacientes críticos da UTI. Evidenciando o papel da assistência da higienização bucal de qualidade, destacando a importância da atuação do cirurgião dentista em equipes multiprofissionais, visto que o risco de focos infecciosos bucais pode contribuir para o agravo e piora do quadro clínico dos pacientes.

Introduction: during the stay in Intensive Care Units (ICUs), hospitalized patients are more vulnerable to changes in the oral cavity resulting from the use of artificial respiration equipment and the immunocompromised state in which they are found. Objective: to identify the main oral manifestations in patients admitted to an ICU, as well as to verify the knowledge of professionals responsible for oral hygiene. Methodology: this is a descriptive quantitative study with cross-sectional design. Data were obtained from the patient's medical records and through an intraoral clinical examination. For professionals responsible for oral hygiene, a questionnaire was used. The analyses were performed in the SPSS version 21.0 program in a descriptive way. Results: the oral manifestations with the highest incidence were tongue coating, dental biofilm, candidiasis, due to the quality of oral hygiene provided and low immunity. Oral and systemic findings related to patients with longer hospital stays were lip dryness, angular cheilitis, depapilated tongue, candidiasis and pneumonia. All professionals responsible for oral hygiene of patients had technical training in nursing and were unaware of important alterations such as dental biofilm and nosocomial pneumonia. Conclusion: the data from this study allow us to conclude that despite the constancy with which oral hygiene is performed, there is a high frequency of oral lesions in critical ICU patients. Evidencing the role of quality oral hygiene assistance, highlighting the importance of the dentist's role in multidisciplinary teams, since the risk of oral infectious foci can contribute to the aggravation and worsening of the clinical condition of patients.

Odontologia hospitalar em tempos de COVID-19 / Hospital Dentistry in COVID-19 times

A pandemia da COVID-19 levou a população mundial a repensar todas as formas de relacionamento humano. Assim como as demais áreas da saúde, a Odontologia Hospitalar também passou por adaptações frente a atual situação. Objetivo: Apresentar as principais mudanças que ocorreram na atuação do Cirurgião-dentista no ambiente hospitalar em decorrência da COVID-19. Revisão de literatura: A prática odontológica baseia-se no uso de instrumentos que promovem a emissão de aerossóis. Diante da ampliação do risco o de disseminação do SARS-CoV-2 durante os procedimentos odontológicos hospitalares, profissionais de saúde bucal devem estar devidamente paramentados e respeitar todos os protocolos estabelecidos para este período. Discussão: Após redução da saliva residual, recomenda-se utilizar o peróxido de hidrogênio 1,0%, previamente a clorexidina 0,12% ou 0,2%, sem álcool, e proceder com a lubrificação oral. A realização da higiene oral em pacientes traqueostomizados para prevenção de PAVM no ambiente hospitalar deve ser mantida a fim de evitar novos casos por infecção de microrganismos diversos ao SARS-CoV-2. Conclusão: A biossegurança durante as práticas odontológicas nunca deve ser negligenciada, principalmente no atual cenário de pandemia.

The COVID-19 pandemic led the world's population to rethink all forms of human relationships. Like other areas of health, Hospital Dentistry has also undergone adaptations to the current situation. Aim: To present the main changes that have occurred in the role of dentists in the hospital environment as a result of COVID-19. Literature review: Dental practice is based on the use of instruments that promote the emission of aerosols. In view of the increased risk or dissemination of SAR-S-CoV-2 during hospital dental procedures, oral health professionals must be properly dressed and respect all the protocols established for this period. Discussion: After reducing residual saliva, it is recommended to use 1.0% hydrogen peroxide, before 0.12% or 0.2% chlorhexidine, without alcohol, and proceed with oral lubrication. The performance of oral hygiene in tracheostomized patients to prevent VAP in the hospital environment should be maintained in order to avoid new cases of infection by microorganisms other than SARS-CoV-2. Conclusion:Biosafety during dental practices should never be ne-glected, especially in the current pandemic scenario.

Inserção da Odontologia Hospitalar na grade curricular dos cursos de Odontologia do sudeste brasileiro / Insertion of Hospital Dentistry in the curricular grade of the southeast brazilian Dentistry courses

Objetivo: Avaliar a inserção da Odontologia Hospitalar nos Projetos Políticos Pedagógicos dos cursos de Odontologia das Instituições de Ensino Superior da Região Sudeste do Brasil. Materiais e Métodos: Realizou-se um estudo transversal e quantitativo, na qual as grades curriculares dos cursos foram analisadas, buscando-se as informações referentes às variáveis: inserção da disciplina, categoria administrativa da instituição, natureza do componente curricular, metodologia de ensino, período de oferta e carga horária. Os dados foram tabulados utilizando o programa GraphPad Prism 8.1.2, sendo analisados por meio de esta-tísticas descritivas. Resultados: Dentre as 176 universidades encontradas, 144 foram avaliadas e incluídas no estudo. Verificou-se que 46 instituições (31,9%) apresentavam a disciplina de Odontologia Hospitalar, sendo que destas, 38 (82,6%) possuem caráter obrigatório. Em relação à meto-dologia de ensino empregada, 21 (45,6%) possuem natureza apenas prática, 10 (21,7%) teórico-prática, 9 (19,5%) apenas teórica e 6 (13,6%) não especificaram a metodologia. A análise da carga horária reservada para a disciplina apresentou uma média de 73,83 horas, sendo a máxima de 176 horas e a mínima de 30 horas. Conclusão: A Odontologia Hospitalar como componente curricular nos cursos de Odontologia exibe-se ainda de maneira bastante discreta. Como o Projeto Político Pedagógico está em constante elaboração e deve acompanhar as transformações e exigências profissionais, estes dados alertam para necessidade de estruturação de diretrizes para consolidação desta área de conhecimento na formação do cirurgião-dentista.

Objective: Evaluate the insertion of Hospital Dentistry in the Pedagogical Political Projects of the Dentistry courses of Higher Education Institution in the Southeast of Brazil. Materials and Methods: A cross-sectional and quantitative study was carried out, in which the curri-cula of the courses were analyzed, seeking information regarding the variables: insertion of the discipline, admi-nistrative category of institution, nature of the curricular component, teaching methodology, period of study and workload. Data were tabulated using GraphPad Prism 8.1.2 software and analyzed using descriptive statistics. Results: 176 universities found, 144 were evaluated and included in the study. It was found that 46 institutions (31.9%) had the discipline of Hospital Dentistry, and 38 (82.6%) are compulsory. Regarding the teaching metho-dology employed, 21 (45.6%) are only practical, 10 (21.7%) theoretical-practical, 9 (19.5%) only theoretical and 6 (13.6%) did not specify the methodology. The analysis of the workload reserved for the course presented an ave-rage of 73.83 hours, with a maximum of 176 hours and a minimum of 30 hours. Conclusion: Hospital Dentistry is a very discrete curricular component in Dentistry courses. As the Pedagogical Political Projects is in constant ela-boration and must follow the changes and professional demands, these data alert to the need for structuring guidelines for consolidation of this area of knowledge in the formation of the dentist.

Desenvolvimento de um manual ilustrado para o cirurgião-dentista da Unidade de Terapia Intensiva: relato de experiência / Development of an illustrated manual for the Intensive Care Unit surgeondentist: experience report / Desarrollo de un manual ilustrado para el cirujano-dentista de la Unidad de Terapia Intensiva: relato de experiencia

Este relato objetiva apresentar o processo de desenvolvimento de um material escrito e ilustrado voltado para o dentista atuante em Unidades de Terapia intensiva, bem como os motivos e justificativas que levaram à decisão de sua necessidade. O cirurgião-dentista tem ampliado sua área de atuação e, por isso, necessita de materiais didáticos que forneçam uma base para essa nova forma de pensar a Odontologia, com um caráter integral e multiprofissional. Por não haver contato dos cirurgiões-dentistas com o ambiente hospitalar durante a graduação, salvo raras exceções, o material didático nesta área foi planejado para abranger desde os conhecimentos básicos até situações que envolvem maior conhecimento para a tomada de decisão. A metodologia utilizada foi o levantamento bibliográfico e a montagem de material escrito na forma de manual, além da produção e tratamento de fotografias ilustrativas, obtidas em um Hospital Universitário durante o processo de cuidado odontológico de pacientes críticos.

This report aims to present the process of developing a written and illustrated material for the dentist in intensive care units, as well as the reasons and justifications that led to the decision of their need. The dental surgeon has expanded his area of practice and, therefore, needs didactic materials that provide a basis for this new way of thinking about Dentistry, with an integral and multiprofessional character. Due to the lack of contact between dental surgeons and the hospital environment during graduation, with few exceptions, the teaching material in this area was designed to cover everything from basic knowledge to situations involving greater knowledge for decision making. The methodology used was the bibliographical survey and the assembly of written material in manual form, as well as the production and treatment of illustrative photographs obtained at a University Hospital during the dental care process of critical patients.

Este relato tiene como objetivo presentar el proceso de desarrollo de un material escrito e ilustrado orientado hacia el dentista actuante en Unidades de Terapia intensiva, así como los motivos y justificaciones que llevaron a la decisión de su necesidad. El cirujano-dentista ha ampliado su área de actuación y, por eso, necesita materiales didácticos que proveen una base para esa nueva forma de pensar la Odontología, con un carácter integral y multiprofesional. Por no haber contacto de los cirujanos-dentistas con el ambiente hospitalario durante la graduación, salvo raras excepciones, el material didáctico en esta área fue planeado para abarcar desde los conocimientos básicos hasta situaciones que involucran mayor conocimiento para la toma de decisión. La metodología utilizada fue el levantamiento bibliográfico y el montaje de material escrito en la forma de manual, además de la producción y tratamiento de fotografías ilustrativas, obtenidas en un Hospital Universitario durante el proceso de cuidado odontológico de pacientes críticos.

Prevalence of HBV and Assessment of Hepatitis B Vaccine Response among Dental Health Care Workers in Dental Teaching Hospital, Umm Al-Qura University, Saudi Arabia.

Hepatitis-B Virus (HBV) infection is a serious health problem that can be prevented by vaccination. Dental Health Care Workers (DHCWs) are at-risk of occupational exposure to HBV infection. This study was aimed to assess the prevalence of HBV and evaluate the immune response to hepatitis B vaccine among DHCWs in Dental Teaching Hospital, Umm Al-Qura University, Saudi Arabia. A cross-sectional study was conducted on 139 DHCWs, 71 males and 68 females. Blood samples were collected and the levels of hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) were measured by Chemiluminescent Microparticle Immunoassay. The prevalence of HBV among DHCWs was zero (0.0%). The hepatitis B vaccine was given to 95% of DHCWs. Among the vaccinated participants, 90.1% (n=119) have protective immunity to hepatitis B. An inverse correlation between anti-HBs levels and increasing the duration of vaccination (P < 0.0001) was found. We compared the anti-HBs levels in 28 students who received childhood vaccine and revaccinated at age of 21. The anti-HBs concentration was greater than 10mIU/mL (protected) in 17.9% of those who had childhood vaccine compared to 100% one-year after revaccination. The mean of anti-HBs levels for childhood vaccine was 5.6 mIU/mL and these levels increased significantly to 620 mIU/mL after recent revaccination (P < 0.0001). In conclusion, Hepatitis B vaccine is effective in prevention of HBV infection among DHCWs. Non-protected individuals should be identified and revaccinated.

BDA hospital dentists survey 2017.

In 2016 the BDA undertook to investigate the demographics and distribution of its hospital members alongside their morale and motivation. This is the first time the BDA had undertaken such a survey and it is the first time any workforce research into the Hospital Dental Services (HDS) has been published by any party. Subsequent freedom of information requests have suggested that BDA HDS member data is representative of the overall HDS workforce. Of particular note is the distribution of some of the 'smaller' specialties with some seemingly only existing at dental school level alongside morale and motivation levels in relation to other dental roles.

Is it necessary to have a dentist within an intensive care unit team? Report of a randomised clinical trial.

OBJECTIVE: To evaluate the effectiveness of dental treatment in improving oral health in critical patients. METHODS: This randomised clinical trial was conducted in a general intensive care unit (ICU) at a tertiary care public facility from 1 January 2011 to 8 August 2013. Data from 254 adult patients staying in the ICU for 48 hours or more were analysed. The experimental group (n = 127) had access to dental treatment provided by a dentist four to five times a week, in addition to routine oral hygiene, whereas the control group (n = 127) had access only to routine oral hygiene, including topical application of chlorhexidine, provided by the ICU nursing staff. The baseline oral health status of the enrolled patients was poor and included edentulism, caries, gingivitis, periodontitis and residual roots. Dental treatment consisted of toothbrushing, tongue scraping, removal of calculus, scaling and root planing, caries restoration and tooth extraction. RESULTS: The Oral Hygiene Index Simplified (OHI-S) and Gingival Index (GI) scores decreased in the experimental group but did not change significantly in the control group during the ICU stay. Dental treatment prevented most of the episodes of respiratory tract infections, as previously reported. No severe adverse events from the dental treatment were observed. CONCLUSION: From an interprofessional perspective, our results support the idea of including dentists in the ICU team to improve oral health in critical patients and effectively prevent respiratory tract infections, in addition to the improvement achievable by applying chlorhexidine alone.

Knowledge, attitudes and practices regarding methicillin-resistant Staphylococcus aureus (MRSA) infection control and nasal MRSA carriage rate among dental health-care professionals.

BACKGROUND: Dental health-care professionals (DHCPs) with nasal colonisation of methicillin-resistant Staphylococcus aureus (MRSA) can serve as a reservoir for MRSA transmission to others and be exposed to self-contamination with MRSA. Evaluating the knowledge, attitudes and actual practice of DHCPs is imperative for appropriate infection control. METHODS: Dentists, dental hygienists and dental technologists from Seoul National University Dental Hospital were recruited to participate in a cross-sectional survey and undergo nasal sampling of MRSA. The survey included demographic questions, six questions about knowledge, eight questions about attitudes/perceptions and six questions about practices/behaviours regarding MRSA infection control. Nasal samples from the participants were analysed for MRSA presence, antimicrobial susceptibility and staphylococcal cassette chromosome mec (SCCmec) typing. MRSA carriers underwent decolonisation with topical mupirocin. RESULTS: Among 139 DHCPs, four (2.9%) were nasal MRSA carriers. Decolonisation was successful in three participants. One participant was decolonised with topical fusidic acid after failure to decolonise with mupirocin. Dentists had a higher knowledge score compared with the other professionals (P < 0.05). Dental hygienists scored higher on practice questions compared with the other professionals (P < 0.05). There was a significant, positive correlation between attitude and practice scores (P < 0.01). CONCLUSIONS: The nasal MRSA carriage rate among DHCPs is 2.9%, which is higher than that in the general population but lower than that in other health-care professionals. Further education of DHCPs on MRSA, especially regarding its seriousness, is needed to improve MRSA infection control in a dental hospital setting.

Planejamento da assistência ao paciente hospitalizado na unidade de terapia intensiva oncológica na perspectiva dos cuidados paliativos / Patient care planning hospitalized in the intensive care unit Oncology palliative care perspective

A pessoa com câncer avançado pode necessitar de hospitalização e em muitas situações, influenciadas pelas incertezas no momento de sua entrada nos serviços é indicada à terapia intensiva. Nestes casos, o planejamento da assistência pode ser conflitante e desafiador e resultar em investimentos obstinados terapeuticamente para oferecer ao paciente uma condição de sobrevivência não mais que vegetativa. Assim, objetivou-se: analisar o entendimento dos profissionais da equipe de saúde multidisciplinar acerca da assistência ao paciente sem possibilidades terapêuticas para a cura no contexto da unidade de terapia intensiva (UTI) oncológica e discutir os objetivos que os profissionais da equipe de saúde buscam alcançar ao planejar esta assistência, na perspectiva dos cuidados paliativos. Estudo descritivo, qualitativo, realizado com profissionais da equipe de saúde multidisciplinar, a saber: enfermeiros, médicos, fisioterapeutas e nutricionistas, que atuam na UTI adulto do Hospital do Câncer I, Instituto Nacional de Câncer, localizado no município do Rio de Janeiro, Brasil. Os dados foram coletados no período entre dezembro de 2015 e maio de 2016. A técnica de coleta de dados utilizada foi a entrevista semiestruturada e os dados foram analisados seguindo referencial metodológico da análise temática, resultando em seis principais núcleos temáticos. Os profissionais descreveram o perfil da clientela adulta em cuidados intensivos na oncologia como peculiar, com predomínio de pacientes para cuidados de fim de vida. Apesar disso, evidenciou-se ausência de um planejamento assistencial estratégico para os pacientes em situação de terminalidade da vida na UTI oncológica, bem como o reconhecimento dos desafios, principalmente éticos, dos processos relacionados com a sua complexidade. No entanto, sinaliza-se uma consciência por parte desses profissionais da importância de se garantir aos pacientes em cuidados intensivos condições terapêuticas menos danosas e sofridas, com vistas a respeitar a dignidade humana no processo de morrer. Contudo, dificuldades foram apontadas na adoção de melhores práticas assistenciais, dentre elas a falta de conhecimento específico, comunicação ineficaz, deficiências relacionadas ao processo de formação profissional sobre cuidados paliativos, necessidade de conscientização de todas as pessoas envolvidas no processo, déficit de recursos humanos, acúmulo de funções, falta de protocolos que norteiem tal assistência e a complexidade no processo de gestão (triagem e alocação) da clientela diante da atual estrutura hospitalar. Desponta como principal estratégia para viabilizar uma prática assistencial humanizada na perspectiva dos cuidados paliativos a necessidade de capacitação da equipe com investimento maciço na educação dos profissionais acerca dos preceitos paliativos, assim como a implementação de estratégias que minimizem o déficit de comunicação entre as equipes, visando favorecer a qualidade da assistência prestada na UTI oncológica. Para integração entre os cuidados curativos e paliativos na UTI oncológica sugere-se o modelo interconsultivo, uma vez que a instituição possui capital humano detentor deste conhecimento específico.(AU)

A importância do cirurgião-dentista em ambiente hospitalar / The importance of the surgeon-dentist at hospital environment

A odontologia hospitalar é a prática de atividades que contribuem com a melhora da saúde geral e qualidade de vida dos indivíduos hospitalizados, os quais apresentam grandes riscos de contração de doenças infecciosas e pulmonares, que, além de prejudicar a saúde bucal, podem acometer outros órgãos e sistemas, agravando o quadro clínico e estendendo a sua estadia na Unidade de Terapia Intensiva (UTI). Assim, a presença do cirurgião dentista dentro da equipe multidisciplinar visa melhorar efetivamente o quadro de saúde geral dos pacientes. O objetivo do estudo foi realizar uma revisão de literatura e retratar a importância da atuação do cirurgião dentista na equipe multidisciplinar em ambiente hospitalar e a relação entre condições orais e sistêmicas que podem influenciar no quadro clínico do paciente internado. Foram consultadas as bases de dados Scielo, PubMed, Medline e LILACS, por meio das palavras chave em português e inglês: odontologia, unidade hospitalar de odontologia, equipe hospitalar de odontologia, unidades de terapia intensiva, intensive care units, dentistry, patient care team, patient care, no período de 2000 a 2017. Foram utilizados 21 artigos cujos achados correspondem a 9 revisões de literatura, 10 artigos observacionais e 2 legislações sobre o tema. Em conclusão, é fundamental a integração do cirurgião dentista habilitado em Odontologia hospitalar dentro das UTIs para realização de medidas preventivas bucais e para melhoria do quadro clínico dos pacientes internados. (AU)

The hospital dentistry is the practice of activities that contribute with the improve of general health and the quality of life of hospitalized individuals, which present big risks of infectious and pulmonar diseases contraction, which in addition to impairing the oral health, can effect other organs and systems, aggravating the patient's clinical condition and keeping it for more time at Intensive Care Unit (ICU). So the presence of a surgeon-dentist into the multidisciplinar team aims to effectively improve the patient's clinical conditions. The objective was to realize a literature review and show the importance of the surgeondentist performance in a multidisciplinar team in hospital environment; also the relationship between oral and systems conditions, that can influence in admitted patient's clinical conditions. It was consulted the Scielo, PubMed, Medline and LILACS data bases, using the keywords in Portuguese and English: intensive care units, dentistry, patient care team, patient care, odontologia, unidade hospitalar de odontologia, equipe hospitalar de odontologia, unidades de terapia intensiva, in the period from 2000 to 2017. Twenty-one articles were used, which findings correspond to 9 literature review, 10 observational articles and 2 laws about the subject. In conclusion, the integration of the enabled surgeon-dentist in hospital dentistry is fundamental into ICU for oral preventive measures and also to improve the admitted patient's clinical conditions. (AU)

Frequency and distribution of teeth treated by single- and multiple- visit root canal treatment in a Nigerian population by differently skilled operators.

BACKGROUND: Single visit root canal treatment (RCT) is being advocated around the world. This study profiles RCT in a Nigerian population and compares pattern of single versus multiple visit RCT to tooth type and skill level of the doctors. METHOD: A retrospective study was carried out on RCT performed in one year by fresh graduates and postgraduate dentists. Records retrieved included patients' sex and age, tooth type, location in the jaw and whether single- or multiple-visit RCT was done. RESULTS: Records of 705 teeth were reviewed, 54.6% belonged to females. Age range was 18-87 years, mean of 31.76 (± 12.31) years. Majority (70.1%) belonged to 20-39 years' age group. Most teeth were located in the maxilla (60.8%) and in posterior regions (73.6%). The most frequently root filled tooth was the mandibular first molar (20.7%) followed by maxillary central incisor (18.4%) then maxillary premolar (12.8%). However, all molars accounted for 47.3%, premolars 26.3% and incisors 25.0%. Canines (1.45%) were least frequently root-filled. Incisors (54.8%) were the teeth most frequently treated in single-visit followed by premolars (28.8%). Most frequently treated by multiple-visit were molars (51.0%). All doctors performed multiple-visit RCT in an approximately equal proportion but a significant percentage of single-visit RCT was carried out by senior doctors (71.2%). CONCLUSION: The most frequently root filled teeth were mandibular first molars. Teeth most likely to be treated by single-visit RCT were incisors. Appropriate operator skill and experience is important in the decision to perform single-visit RCT. Single-visit RCT is advocated in the developing environment.

The Impending Oral Health Crisis.

Last May, the New York State Dental Association and the New York State Dental Foundation convened the first "Oral Health Stakeholders' Summit on the Future of Special Needs Dentistry, Hospital Dentistry and Dental Education." The summit was chaired by David J. Miller, then NYSDA President Elect, and Carl H. Tegtmeier, then chair of the NYSDA Council on Dental Health Planning and Hospital Dentistry. It brought together experts, called to frame the issues and provide information necessary for a reasoned response. And it sought input from attendees to develop recommendations to ensure that patients with intellectual and developmental disabilities, as well as an aging population with Alzheimer's disease and dementia, have access to appropriate oral health care in the years ahead. Over 100 participants, representing dentistry, hospital training programs, third-party payers, state government offices and related patient support associations, attended the two-day event in Albany. They focused on the impact of reductions in funding, the transition of Medicaid services into a managed care model, a loss of service providers and the need for expanded training programs. They heard from speakers epresenting a broad spectrum of those involved in he oral health care of patients with intellectual and evelopmental disabilities, the Alzheimer's Association, dental educators and researchers, hospital dentistry and the benefits industry, whose presentations focused on a looming oral health crisis threatening access to dental care for patients with disabilities.

An Outcomes Study of 40 Years of Graduates of a General Practice Dental Residency.

Assessing program quality and outcomes is essential to improve postgraduate dental education. This study's aims were to document career direction and practice patterns of graduates of the Brigham and Women's Hospital (BWH) General Practice Residency (GPR), to compare BWH GPR outcomes to those of other American GPRs, and to identify characteristics of the BWH GPR program that trainees valued. This was a retrospective cohort study with a sample comprised of BWH GPR graduates between 1973 and 2013. Outcomes examined included pursuit of specialty training and positions on academic or hospital staff. Data sources were a survey of BWH GPR graduates and published national surveys. Of the 190 BWH graduates (95% of total) who were located and contacted, 133 (70% response rate) completed the survey. Compared to national survey data, BWH GPR graduates were significantly more likely to be specialists, full-time hospital staff, or full-time or part-time dental school faculty. Most BWH graduates (96.2%) ranked the program as outstanding or good. Faculty characteristics were considered by BWH graduates to be the most important factors in judging program quality. Since faculty characteristics were the most important factors in residents' judgment of program quality, GPR programs should recruit, maintain, and develop a quality faculty in order to attract students.

What is the role of the oral and maxillofacial department in the preoperative management of patients awaiting cardiac operations?

There is limited evidence and guidance on best practice regarding preoperative dental assessments of patients awaiting cardiac operations. To analyse current practice in oral and maxillofacial units across the United Kingdom, we did a telephone survey to find out how these patients are managed. All maxillofacial departments in the United Kingdom were contacted, with a response rate of 77%. Those attached to dental schools were excluded. Most departments did extractions only, and in many, patients were assessed and treated within 7 days of being referred, although this varied. Most units did not offer antibiotic prophylaxis to patients at high risk of infective endocarditis, but some did after advice had been sought from a cardiologist. Respondents in 76% thought that preoperative dental assessments for cardiac patients were an appropriate use of resources. We propose a more integrated pathway for the management of these patients (particularly considering the pressure on time for treatment) that focuses primary and secondary resources accordingly.