Oral healthcare management practices in Brazil: systematic review and metasummary

Universal health coverage is a global target included in the United Nations Sustainable Development Goals agenda for 2030. Healthcare in Brazil has universal coverage through the Unified Health System (SUS), which guarantees health as basic right to the Brazilian population. Considering the principles of SUS, public oral healthcare management is a huge challenge. Aim: To identify good management practices for quality care adopted by local public oral healthcare managers and teams around Brazil. Methods: This study was registered with PROSPERO (CRD42017051639). Five databases (PubMed, Embase, Web of Science, Scopus and Lilacs) as well as the reference lists and citations of the included publications were searched according to PRISMA guidelines. Results:A total of 30,895 references were initially found, which were evaluated according to the defined eligibility criteria. Twenty qualitative studies, eight surveys and two mixed-model studies were selected. The practices (codes) were organized into three main groups (families), and the Frequency of the Effect Size (FES) of each code was calculated. Among the 20 codes identified, the most relevant ones were: Diagnosis and Health Planning (FES=80%) and Family Health Strategy(FES=66,7). The Intensity of the Effect Size of each study was also calculated to demonstrate the individual contribution of each study to the conclusions. Conclusion: The evidence emerging from this review showed that healthcare diagnosis, planning, and performance based on the family health strategy principles were the most relevant practices adopted by public oral healthcare managers in Brazil. The widespread adoption of these practices could lead to improved oral healthcare provision and management in Brazil

Indicadores de produção ambulatorial de Cursos de Odontologia do Brasil / Outpatient production indicators of Dentistry Courses in Brazil

A formação do cirurgião-dentista generalista capaz de atuar em diferentes cenários de prática e exercer atividades na área de promoção a saúde, depende de um Projeto Político Pedagógico (PPP) alinhado às Diretrizes Curriculares Nacionais para cursos de Odontologia (DCNO). O objetivo deste estudo foi avaliar a produção clínica de alunos da graduação de cursos de Odontologia de Instituições de Ensino Superior (IES) públicas brasileiras, no período de 2014 a 2019, por meio da construção de indicadores de procedimentos odontológicos individuais e coletivos. Foram selecionadas por conveniência 8 IES das 5 regiões do Brasil e analisados os procedimentos odontológicos do SIA-SUS de 5 categorias: G1 (Ações de promoção e prevenção), G2 (Procedimentos com finalidadediagnóstica), G3: (Procedimentos clínicos), G4 (Procedimentos cirúrgicos) e G5 (Órteses e próteses). Os indicadores foram construídos considerando a produção anual e o número de vagas ofertadas pela IES. Observou-se grande variação nos valores médios dos indicadores de procedimentos entre as IES avaliadas. A IES B apresentou os maiores valores para G1 (1.511,4) e G3 (892,2), enquanto a IES E, valores inexistentes para G1 e G5. Embora houvesse carga horária no PPP de todas as IES para os grupos de procedimentos estudados, algumas não apresentaram valores registrados de produção nos G1 e G5. Conclui-se que houve uma alta variabilidade na produção clínica de alunos da graduação de curso de Odontologia vinculados ao SUS em procedimentos odontológicos individuais e coletivos, apontando para a necessidade de melhorias nos registros e no monitoramento desses indicadores para melhor formação dos futuros profissionais e qualificação dos serviços prestados (AU).

The training of the general dentist, who is capable of working in different practice scenarios and performing activities in the health promotion area, depends on a Political Pedagogical Project (PPP) aligned with the National Curriculum Guidelines for Dentistry Courses (DCNO in Portuguese).The objective of this study was to evaluate by indicators in the clinical production of undergraduate students in the Dentistry course of the Brazilian public Higher Education Institutions (HEIs) from 2014 to 2019. EightHEIs from the 5 Brazilian regions were selected for convenience and the dental procedures of the SIA-SUS of 5 categories were analyzed: G1 (promotion and prevention actions), G2 (procedures for diagnostic purposes), G3: (clinical procedures), G4 (surgicalprocedures) and G5 (orthotics and prosthetic). The indicators were organized considering the annual production and the number of vacancies offered by the HEIs. A great variation was observed in the average values of the procedure indicators among the evaluated HEIs. HEI B presented the highest values for G1 (1,511.4) and G3 (892.2), while HEI E, non-existent values for G1 and G5.Although there is a workload in the PPP of all HEIs for the groups of procedures studied, some did not show recorded productionvalues in G1 and G5. It was concluded that there was high variability in the clinical production of undergraduate dentistry students integrated to Unified Health System (SUS in Portuguese), in individual and collective dentistry procedures, pointing to the need for improvements in the records and monitoring of these indicators for better training of future professionals and qualification of the services provided (AU).

Association of Oral Health Teams implantation with collective actions and extractions in Paraná State, Brazil. / Associação da implantação de Equipes de Saúde Bucal com ações coletivas e exodontia no Estado do Paraná, Brasil.

This article aims to monitor the indicators of outpatient production of Dentistry and to evaluate the association of collective action and extraction indicators with the number of Oral Health Teams (OHT) between 2006 and 2015 in Paraná. In this longitudinal ecological study, consolidated secondary data were analyzed (collective actions of supervised brushing-SB, topical application of fluoride-TAF, fluoride mouthwash-FM, oral examination for epidemiological purposes-OE and extractions of permanent teeth-EX) from the Ambulatory Information System (SIA-SUS) and OHT numbers from the National Registry System of Health Establishments. Descriptive analyzes and Pearson's correlation were performed, with significance level of p<0.05. It was verified the increase of the OHT implantation over time and a strong positive correlation with collective procedures of SB (r=0.78; p=0.007) and FM (r=0.76; p=0.011) and moderate negative correlation with EX (r=-0.53). It was concluded that the evaluated indicators showed that the implementation of Oral Health Teams may have contributed to changes to the healthcare model, with an increase in preventive collective procedures and reduction of tooth loss in Paraná.

O artigo tem por objetivo monitorar a produção ambulatorial em Odontologia e avaliar a associação de indicadores de ação coletiva e exodontia com o número de Equipes de Saúde Bucal (ESB) entre 2006 e 2015, no Paraná. Neste estudo ecológico longitudinal foram analisados dados secundários consolidados (ações coletivas de escovação supervisionada-ES, aplicação tópica de flúor-ATF, bochecho fluorado-BF, exame bucal com finalidade epidemiológica-EB e exodontia de dente permanente-EXO) do Sistema de Informação Ambulatorial e números de ESB no Sistema de Cadastro Nacional de Estabelecimentos de Saúde. Foram realizadas análises descritivas e correlação de Pearson, com nível de significância de p<0,05. Verificou-se um aumento de ESB implantadas ao longo do tempo e correlação forte positiva com procedimentos coletivos de ES (r=0,78; p=0,007) e BF (r=0,76; p=0,011) e correlação moderada negativa com EXO (r=-0,53). Conclui-se que os indicadores avaliados demonstraram que a implantação de Equipes de Saúde Bucal pode ter contribuído para mudanças no modelo de atenção, com aumento dos procedimentos coletivos preventivos e redução de perdas dentárias no Paraná.

System dynamics modeling for tooth decay treatment in Brazilian children.

Prevention and health promotion are considered important strategies to control oral diseases. Dental caries is preventable disease and remains the most common chronic disease that affects mainly low income children and still considered the main cause of tooth loss in adulthood in Brazil. The aim of this study is to present a System Dynamics model (SDM) specifically developed with the Stella Architect software to estimate the cost and clinical hours required to control the evolution of dental caries in preschool children in Maringá, Brazil. Two main strategies to control caries were considered in the model: the application of fluoride varnish on teeth presenting white spots, and the use of Atraumatic Restorative Treatment (ART) in cavitated carious lesions without pulp involvement. The parameters used in the model were: number of people covered by a local oral health team = 4,000; number of children up to 5 years = 7% of the population; children's decayed, missing, filled teeth (dmft) index = 2.4; time/cost of 4 applications of fluoride varnish = 5 minutes/US$ 0.716; and time/cost of each ART restoration = 15 minutes/US$ 1.475. The SDM generated an estimated total cost of US$698.00, and a total of 112 clinical hours to treat the population in question. The use of the SDM presented here has the potential to assist decision making by measuring the material and human resources required to prevent and control dental caries at an early age.

System dynamics modeling for tooth decay treatment in Brazilian children

Abstract Prevention and health promotion are considered important strategies to control oral diseases. Dental caries is preventable disease and remains the most common chronic disease that affects mainly low income children and still considered the main cause of tooth loss in adulthood in Brazil. The aim of this study is to present a System Dynamics model (SDM) specifically developed with the Stella Architect software to estimate the cost and clinical hours required to control the evolution of dental caries in preschool children in Maringá, Brazil. Two main strategies to control caries were considered in the model: the application of fluoride varnish on teeth presenting white spots, and the use of Atraumatic Restorative Treatment (ART) in cavitated carious lesions without pulp involvement. The parameters used in the model were: number of people covered by a local oral health team = 4,000; number of children up to 5 years = 7% of the population; children's decayed, missing, filled teeth (dmft) index = 2.4; time/cost of 4 applications of fluoride varnish = 5 minutes/US$ 0.716; and time/cost of each ART restoration = 15 minutes/US$ 1.475. The SDM generated an estimated total cost of US$698.00, and a total of 112 clinical hours to treat the population in question. The use of the SDM presented here has the potential to assist decision making by measuring the material and human resources required to prevent and control dental caries at an early age.

Antimicrobial effect of photodynamic therapy using erythrosine/methylene blue combination on Streptococcus mutans biofilm.

BACKGROUND: Photodynamic therapy (PDT) has demonstrated promising results in the treatment of several clinical pathologies through the photochemical reaction caused by the combination of a photosensitizer and a light source. The objective of this study was to evaluate the antimicrobial effect of the combination of the photosensitizers (PSs) erythrosine/methylene blue activated by a white halogen light device on Streptococcus mutans biofilm. METHODS: Two separate experiments were conducted, the first using the PSs at the concentration of 100 µM, and the second 250 µM. The PSs were tested on S. mutans biofilms cultured for 24 h in isolation, in combination, with and without light activation for 2 min fractionated in 4 periods of 30 s. After treatment, biofilms were diluted and plated on BHI medium and incubated for 24 h for colony forming units (CFU) counting. The results (log10) were analyzed with ANOVA followed by Tukey test (p < 0.05). RESULTS: The erythrosine/methylene blue combination activated by white halogen light at 100 and 250 µM, and erythrosine at 250 µM, methylene blue at 250 µM presented significantly reduced cell counts (3.2 log10, 5.3 log10, 4.5 log10, 4.3 log10, respectively) when compared to controls (p < 0.05). CONCLUSION: PDT with the combination of erythrosine/methylene blue demonstrated better results that the PSs in isolation regardless of the concentration. The use of this combination at the concentration of 250 µM shows promise as an antibacterial treatment for carious lesions and should be further assessed.

Differential transcription of virulence genes in Aggregatibacter actinomycetemcomitans serotypes.

BACKGROUND: Aggregatibacter actinomycetemcomitans serotypes are clearly associated with periodontitis or health, which suggests distinct strategies for survival within the host. OBJECTIVE: We investigated the transcription profile of virulence-associated genes in A. actinomycetemcomitans serotype b (JP2 and SUNY 465) strains associated with disease and serotype a (ATCC 29523) strain associated with health. DESIGN: Bacteria were co-cultured with immortalized gingival epithelial cells (OBA-9). The adhesion efficiency after 2 hours and the relative transcription of 13 genes were evaluated after 2 and 24 hours of interaction. RESULTS: All strains were able to adhere to OBA-9, and this contact induced transcription of pgA for polysaccharide biosynthesis in all tested strains. Genes encoding virulence factors as Omp29, Omp100, leukotoxin, and CagE (apoptotic protein) were more transcribed by serotype b strains than by serotype a. ltxA and omp29, encoding the leukotoxin and the highly antigenic Omp29, were induced in serotype b by interaction with epithelial cells. Factors related to colonization (aae, flp, apaH, and pgA) and cdtB were upregulated in serotype a strain after prolonged interaction with OBA-9. CONCLUSION: Genes relevant for surface colonization and interaction with the immune system are regulated differently among the strains, which may help explaining their differences in association with disease.