Role of management and human resource factors on matrix support in secondary oral health care in Brazil.

OBJECTIVES: To investigate the association between health management and human resource factors on matrix support (MS) in a nationally representative sample of Dental Specialty Centres (DSCs) in Brazil. METHODS: This survey included 1042 DSCs (Response rate = 94.99%) in the second cycle of the National Program for the Improvement of the Quality and Access to the Dental Specialty Centres (PMAQ-CEO, in Portuguese) in 2018. Previously trained interviewers extracted information on MS, health management and human resources of the DSC by using a structured instrument. An MS score was created by adding the number of positive answers to the 10 MS questions. Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios (RR) and corresponding 95% confidence interval (CI). RESULTS: Of all the DSCs (n = 1042), 116 (11.1%) performed all 10 MS procedures. Those DSCs with a manager who had a higher education degree in the area of Public Health or Public Management (RR = 1.01, 95% CI, 1.01-1.02) and with human resources that received incentives, bonuses or financial awards for performance related to the PMAQ-CEO result (RR = 1.01 95% CI 1.01-1.02) are more likely to perform MS, when compared to the reference categories. The DSCs that are more likely to perform MS include those that developed actions as a result of periodic planning and evaluation with confirmatory documentation (RR = 1.06, 95% CI; 1.01-1.10); those that received support for planning and organizing the work scheme (RR = 1.03, 95% CI; 1.01-1.05); those that monitored and analysed the goals set for each specialty offered at the DSC, with (RR = 1.06, 95% CI; 1.01-1.10) or without confirmatory documentation (RR = 1.06, 95%CI; 1.02-1.11); those whose team periodically performed self-assessment processes, using the Ministry of Health's formal self-assessment (AMAQ in Portuguese) (RR = 1.04, 95% CI; 1.02-1.05); those who followed clinical guidelines (with confirmatory documentation) regarding the referral of patients from primary care to the DSC (RR = 1.02, 95% CI; 1.01-1.04). On the contrary, DSCs that did not use the results achieved in previous PMAQ cycles in the organization of the DSC's team work scheme proved to be less likely to perform MS (RR = 0.98, 95% CI; 0.96-0.99). CONCLUSIONS: Matrix support is associated with human resources and management factors in secondary oral health care in Brazil. Continuing professional development and some management characteristics are important for secondary dental care quality and could be considered in health policy initiatives.

Mother's education and family relations protect children from dental caries experience: a salutogenic approach

Abstract The objective of this study was to identify dental caries-protective factors among 5-year-old children using the salutogenic theory. A cross-sectional study was conducted in a small-sized municipality in the Southeast region of Brazil, with a representative sample of 247 children registered in preschool and their respective mothers. The data were collected through questionnaires administered to the mothers about the socioeconomic, behavioral, and biological aspects of the mother and children. Additionally, the collections included validated instruments concerning psychosocial aspects, such as a sense of coherence, resilience, family cohesion and religiosity, and intraoral examinations of the children through the decayed-missing-filled primary teeth (dmft) index. All examinations were performed by a trained and calibrated examiner. The non-adjusted and adjusted odds ratios (OR) and their respective confidence intervals (CI) were estimated using multiple logistic regression with a hierarchical model. Among the examined children, 41.7% were caries-free. In the final model, the chances of the absence of dental caries experience (dmft = 0) were greater in children with mothers who had higher education levels (> 8 years of study) (OR = 2.55 [95%CIi:1.42-4.59]) and those who lived in an environment of high family cohesion (OR = 3.66 [95%CI: 1.19-11.29]). The results indicated that mothers' level of education and family relationships are protective factors against dental caries in 5-year-old children, which overlapped with behavioral and biological factors.

Association of sociodemographic factors with the prescription pattern of opioids for dental patients: A systematic review protocol.

INTRODUCTION: Oral health practitioners are responsible for a significant share of opioid prescriptions that seem to be influenced by many aspects, including sociodemographic factors. However, there is no consensus on the factors associated with opioid prescription in Dentistry. OBJECTIVE: To identify whether patients' sociodemographic factors are associated with the prescription pattern of opioids in Dentistry. MATERIALS AND METHODS: This systematic review will include observational studies (cross-sectional, case-control, and cohort). Electronic searches will be conducted in MEDLINE (PubMed), EMBASE, Scopus, Web of science, LILACS, SciELO, and Google Scholar. Grey literature will also be consulted. Two independent reviewers will screen all retrieved articles for eligibility, extract data, and assess the methodological quality of the included studies. The results will be presented as a narrative synthesis and, where possible, a meta-analysis will be conducted. Certainty of the evidence will be assessed with the Grading of Recommendations, Assessment, Development, and Evaluation approach. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020211226.

Contextual and individual factors associated with dental pain in adolescents from Southeastern Brazil

Abstract The aim of this study was to assess the factors associated with dental pain in adolescents from the state of Minas Gerais, Brazil. Individual data on adolescents aged 15 to 19 years were collected from the SB Minas survey secondary database. Dental pain over the past 6 months, assessed by a questionnaire, was used as the dependent variable. Sex, income, skin color, prevalence of untreated dental caries, periodontal health, dental treatment needs, and time of last dental appointment were analyzed as individual covariates. Allocation factor, Human Development Index (HDI), Gini coefficient, illiteracy rate, unemployment, 50% and 25% of the Brazilian monthly minimum wage, primary healthcare coverage, oral health team coverage, access to individual healthcare, and supervised toothbrushing average rate were the analyzed contextual variables. A multilevel analysis was conducted for the individual and contextual variables. Statistical analyses used hierarchical linear and nonlinear modeling to infer an association between the different levels. Male adolescents had a lower prevalence of dental pain (OR = 0.53; 95%CI = 0.37-0.75). There was an association between dental pain and low income (OR = 1.58; 95%CI = 1.07-2.33), prevalence of untreated dental caries (OR = 1.25; 95%CI = 1.11-1.40), periodontal health (OR = 1.80; 95%CI = 1.04-3.09), and dental treatment needs (OR = 6.93; 95%CI = 3.96-12.14). Sociodemographic and clinical factors at the individual level were associated with the outcome but not with contextual variables. These findings reinforce the need to address these factors for effective community health actions.

Assessment on Oral Health Knowledge, Attitude, and Behaviour and its Association with Sociodemographic and Habitual Factors of South Indian Population

ABSTRACT Objective: To assess the oral health knowledge, attitude, behaviour, and its association with sociodemographic and habitual factors among South Indian Population. Material and Methods: A total of 288 adults living in a residential community situated in Chennai were selected by systematic random sampling method participated in this cross-sectional study. Data collection was carried out using a validated questionnaire. Results: About 97.9% of the participants in our study had good knowledge, 33.3% had a positive attitude and 48.2% had adequate oral health behaviour. Sociodemographic and habitual factors like diet (p=0.006), education (p=0.009), and employment (p=0.003) were significantly associated with knowledge. On the other hand, diet (p=0.012) was the only factor significantly associated with attitude. Ownership of house (p= 0.030) was significantly associated with behaviour and no factor was associated with all three KAB profiles. Absence of correlation were identified between Knowledge-Attitude (r=0.11, p=0.23), Knowledge-Behaviour (r= -0.037, p= 0.68) and Attitude-Behaviour (r =0.01, p=0.94). Conclusion: It has been found a massive number of participants possessed a high knowledge level towards oral health. On the other hand, less than half of the participants had a positive attitude and adequate behaviour towards oral health. No positive linear correlation was seen among knowledge, attitude, and behaviour towards oral health.

Degree of family cohesion and social class are associated with the number of cavitated dental caries in adolescents.

The aim of this study was to evaluate the association between number of cavitated dental caries in adolescents and family cohesion, drug use, sociodemographic factors and visits to the dentist. A cross-sectional study was conducted with 746 adolescents aged 15 to 19 years from Campina Grande, Brazil. The parents answered a questionnaire addressing sociodemographic data, and the adolescents answered questionnaires on drug use, type of family cohesion and visits to the dentist. Two examiners underwent training and calibration exercises (K > 0.80) to diagnose dental caries using the Nyvad criteria. A directed acyclic graph was created to select the variables to be controlled in the statistical model. Associations between the independent variables and the outcome were determined using robust Poisson Regression analysis for complex samples (α = 5%). Rate ratios (RR) and 95% confidence intervals (CI) were calculated. The prevalence of dental caries and cavitated lesions among the adolescents was 92.8% and 41.6%, respectively. The following variables remained associated with the number of cavitated lesions in the multivariate analysis: disengaged (RR: 6.30; 95%CI: 1.24-31.88; p = 0.028 ), separated (RR: 4.80; 95%CI: 1.03-22.35; p = 0.046) and connected (RR: 5.23; 95%CI: 1.27-21.59; p = 0.024) levels of family cohesion, and high social class (RR: 0.55; 95%CI: 0.39-0.76; p = 0.001). In conclusion, this paper posits that adolescents with a lower socioeconomic status, and those whose family cohesion was classified as disengaged, separated or connected, had a larger number of cavitated lesions.

Socioeconomic status and family functioning influence oral health literacy among adolescents.

OBJECTIVE: Evaluate socio-demographic, family and behavioral factors associated with oral health literacy (OHL) in adolescents. METHODS: Cross-sectional study conducted with adolescents aged 15 to 19 years in Campina Grande, Brazil. Parents/guardians answered a questionnaire addressing socio-demographic data. The adolescents answered validated instruments on family cohesion and adaptability (family adaptability and cohesion evaluation scale), drug use (alcohol, smoking and substance involvement screening test), type of dental service used for last appointment and OHL (Brazilian version of the Rapid Estimate of Oral Health Literacy in Dentistry). Two dentists were trained to evaluate OHL (K = 0.87-0.88). Descriptive analysis was performed, followed by Poisson regression analysis (α = 5%). A directed acyclic graph was used to select independent variables in the study. RESULTS: The following variables remained associated with better OHL: high mother's schooling level (RR = 1.07; 95%CI: 1.03-1.12), high income (RR = 1.04; 95%CI: 1.01-1.09), white ethnicity/skin color (RR = 1.05; 95%CI: 1.01-1.10), married parents (RR = 1.04; 95%CI: 1.01-1.09), "enmeshed" family cohesion (RR = 1.21; 95%CI: 1.12-1.30), "structured" (RR = 1.06; 95%CI: 1.01-1.12) or "rigid" (RR = 1.11; 95%CI: 1.04-1.19) family adaptability, having more than five residents in the home (RR = 1.07; 95%CI: 1.01-1.14) and having used a private dental service during the last appointment (RR = 1.08; 95%CI: 1.03-1.13). CONCLUSION: Family functioning and socio-demographic factors influence the level of oral health literacy among adolescents.

Socioeconomic status and family functioning influence oral health literacy among adolescents

ABSTRACT OBJECTIVE Evaluate socio-demographic, family and behavioral factors associated with oral health literacy (OHL) in adolescents. METHODS Cross-sectional study conducted with adolescents aged 15 to 19 years in Campina Grande, Brazil. Parents/guardians answered a questionnaire addressing socio-demographic data. The adolescents answered validated instruments on family cohesion and adaptability (family adaptability and cohesion evaluation scale), drug use (alcohol, smoking and substance involvement screening test), type of dental service used for last appointment and OHL (Brazilian version of the Rapid Estimate of Oral Health Literacy in Dentistry). Two dentists were trained to evaluate OHL (K = 0.87-0.88). Descriptive analysis was performed, followed by Poisson regression analysis (α = 5%). A directed acyclic graph was used to select independent variables in the study. RESULTS The following variables remained associated with better OHL: high mother's schooling level (RR = 1.07; 95%CI: 1.03-1.12), high income (RR = 1.04; 95%CI: 1.01-1.09), white ethnicity/skin color (RR = 1.05; 95%CI: 1.01-1.10), married parents (RR = 1.04; 95%CI: 1.01-1.09), "enmeshed" family cohesion (RR = 1.21; 95%CI: 1.12-1.30), "structured" (RR = 1.06; 95%CI: 1.01-1.12) or "rigid" (RR = 1.11; 95%CI: 1.04-1.19) family adaptability, having more than five residents in the home (RR = 1.07; 95%CI: 1.01-1.14) and having used a private dental service during the last appointment (RR = 1.08; 95%CI: 1.03-1.13). CONCLUSION Family functioning and socio-demographic factors influence the level of oral health literacy among adolescents.

Degree of family cohesion and social class are associated with the number of cavitated dental caries in adolescents

Abstract The aim of this study was to evaluate the association between number of cavitated dental caries in adolescents and family cohesion, drug use, sociodemographic factors and visits to the dentist. A cross-sectional study was conducted with 746 adolescents aged 15 to 19 years from Campina Grande, Brazil. The parents answered a questionnaire addressing sociodemographic data, and the adolescents answered questionnaires on drug use, type of family cohesion and visits to the dentist. Two examiners underwent training and calibration exercises (K > 0.80) to diagnose dental caries using the Nyvad criteria. A directed acyclic graph was created to select the variables to be controlled in the statistical model. Associations between the independent variables and the outcome were determined using robust Poisson Regression analysis for complex samples (α = 5%). Rate ratios (RR) and 95% confidence intervals (CI) were calculated. The prevalence of dental caries and cavitated lesions among the adolescents was 92.8% and 41.6%, respectively. The following variables remained associated with the number of cavitated lesions in the multivariate analysis: disengaged (RR: 6.30; 95%CI: 1.24-31.88; p = 0.028 ), separated (RR: 4.80; 95%CI: 1.03-22.35; p = 0.046) and connected (RR: 5.23; 95%CI: 1.27-21.59; p = 0.024) levels of family cohesion, and high social class (RR: 0.55; 95%CI: 0.39-0.76; p = 0.001). In conclusion, this paper posits that adolescents with a lower socioeconomic status, and those whose family cohesion was classified as disengaged, separated or connected, had a larger number of cavitated lesions.

A national study on the use of opioid analgesics in dentistry.

The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.

A national study on the use of opioid analgesics in dentistry

Abstract The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.

Regional differences in infection control conditions in a sample of primary health care services in Brazil / Diferenças regionais nas condições de controle de infecções em uma amostra de serviços de atenção primária no Brasil / Diferencias regionales en las condiciones del control de infecciones en una muestra de servicios de atención primaria en Brasil

International guidelines have pointed out the importance of the physical environment of health care facilities in preventing and controlling infection. We aimed to describe the physical environment of dental care facilities in Brazil in 2014, focusing on characteristics designed to control infections. Exactly 16,202 dental offices in the Brazilian Unified National Health System (SUS) participated in this survey. Trained researchers extracted information about the infection control characteristics of health facilities by using a structured instrument. We used data from 12 dichotomous questions that evaluated the wall, floor, sink and tap conditions, and the presence and condition of sterilization equipment. We calculated a score by summing the number of characteristics handled appropriately for infection control, which could range from 0 to 12. Hierarchical cluster analyses were developed. None of the 12 criteria were met by all the oral health teams. Only 208 (1.3%) dental offices correctly performed all 12-infection control practices. Two clusters, with different frequencies of structure for infection control in dental offices, were identified. South and Southeast regions had the highest frequencies for Cluster 1, with better structure of infection control in dental offices. Dental care facilities of oral health teams were not typically meeting the infection control guidelines regarding clinic design and equipment. Adherence to the guidelines varied among the Brazilian geographic regions.

As diretrizes internacionais destacam a importância do ambiente físico dos serviços de saúde para prevenir e controlar as infecções. Procuramos descrever o ambiente físico em serviços de saúde bucal no Brasil em 2014, com enfoque nas características programadas para controlar as infecções. Precisamente 16.202 consultórios odontológicos no Sistema Único de Saúde (SUS) participaram na pesquisa. Pesquisadores treinados coletaram informações sobre as características do controle de infecções nesses serviços de saúde, utilizando um instrumento padronizado. Utilizamos dados de 12 perguntas dicotômicas que avaliavam as condições das paredes, piso, pia e torneira e a presença e as condições do equipamento de esterilização. Calculamos um escore pela soma do número de características administradas adequadamente para o controle de infecções, variando de 0 a 12. Foram desenvolvidas análises hierárquicas de clusters. Nenhum dos 12 critérios foi atendido por todas as equipes de saúde bucal. Apenas 208 (1,3%) dos consultórios odontológicos realizavam todas as 12 práticas de controle de infecções. Foram identificados dois clusters com distintas frequências de estruturas para controle de infecções nos consultórios odontológicos. As regiões Sul e Sudeste mostraram as maiores frequências no Cluster 1, com melhor estrutura de controle de infecções nos consultórios odontológicos. De maneira geral os serviços de saúde bucal não atendiam as diretrizes para o controle de infecções, referentes à planta física e equipamento dos consultórios. A aderência às diretrizes variava de acordo com a região do país.

Las directrices internacionales destacan la importancia del ambiente físico de los servicios de salud para prevenir y controlar infecciones. Procuramos describir el ambiente físico en servicios de salud bucal en Brasil en 2014, centrándonos en las características programadas para controlar las infecciones. Precisamente 16.202 consultorios odontológicos del Sistema Único de Salud (SUS) participaron en la investigación. Investigadores entrenados recogieron información sobre las características del control de infecciones en esos servicios de salud, utilizando un instrumento estandarizado. Utilizamos los datos procedentes de 12 preguntas dicotómicas que evaluaban las condiciones de las paredes, suelo, fregadero y grifo, además de la existencia y condiciones del equipamiento de esterilización. Calculamos una puntuación para la suma del número de características administradas adecuadamente para el control de infecciones, variando de 0 a 12. Se desarrollaron análisis jerárquicos de clúster. Ninguno de los 12 criterios fue observado por todos los equipos de salud bucal. Solamente 208 (1,3%) de los consultorios odontológicos realizaban las 12 prácticas de control de infecciones al completo. Se identificaron dos clústeres con distintas frecuencias de estructuras para el control de infecciones en los consultorios odontológicos. Las regiones Sur y Sudeste mostraron las mayores frecuencias en el Clúster 1, con una mejor estructura de control de infecciones en los consultorios odontológicos. De manera general, los servicios de salud bucal no atendían a las directrices para el control de infecciones, referentes a las instalaciones físicas y equipamiento de los consultorios. La adherencia a las directrices variaba de acuerdo con la región del país.

Hospital Dental Treatment for Special Health Care Needs Patients in Minas Gerais state, Brazil: A Cluster Analysis

Objective: To describe and group some demographic and healthcare characteristics of hospital dental care for the special health care needs population. Material and Methods: Cross-sectional census survey with a total of 1,063 visits with special health care need patients under general anesthesia or sedation at the Brazilian Health System Minas Gerais, Brazil, over 12 months. Clinical diagnosis was divided into "mental and behavioral disorders and diseases of the nervous system" and "others". Age group, gender, clinical diagnosis and care by a general dentist were submitted to descriptive and multivariate cluster analysis. The analysis was performed using the software SPSS version 19.0. Results: Cluster 1 (N=173) had no ICD codes for nervous system (NS) diseases and mental and behavioral disorders. Clusters 2 (N=564) and 3 (N=326) are quite similar except for gender distribution. Cluster 1 was 3.5 times more frequent among non-host cities than HER host cities. Dental treatment was mostly performed on males diagnosed with mental and behavioral disorders and diseases of the NS who were over the age of 25 years and were seen by general dentists. The clusters were distributed unevenly between EHR host and non-host cities. Conclusion: Non-host performed more frequently treatment for patients with no mental and behavioral disorders and diseases of the NS than EHR host cities.

Exodontias no Sistema Único de Saúde em Minas Gerais: uma série temporal de 15 anos / Tooth extraction in the Brazilian Health System, Minas Gerais state: a 15-year time-series

Objetivo: Avaliar a tendência histórica de extrações dentárias no Estado de Minas Gerais entre os anos de 1998 e 2012. Métodos: Trata-se de um estudo de série temporal de exodontias de dentes permanentes no Estado de Minas Gerais, tendo sido os dados coletados no Sistema de Informações Ambulatoriais do Sistema Único de Saúde em 2013. Duas taxas de exodontias foram calculadas, ano a ano. A primeira refere-se à razão entre número total de exodontias de dentes permanentes dividida por todos os procedimentos preventivos, restauradores e cirúrgicos da atenção primária. A segunda foi a razão entre o número total de exodontias de dentes permanentes pelo número de habitantes. A análise estatística envolveu a construção de curvas de tendência histórica. Resultados: As duas taxas de exodontias comportaram-se de maneira errática no período avaliado. Houve uma ligeira tendência de aumento na taxa de exodontias por procedimentos da atenção primária e ligeira tendência de redução na taxa de exodontias pela população do Estado de Minas Gerais. Conclusão: As ligeiras tendências de aumento ou redução das taxas de exodontias revelam que as mesmas permaneceram constantes no período avaliado no Estado de Minas Gerais.(AU)

Aim: To evaluate the time-series of permanent tooth extraction in the state of Minas Gerais between the years 1998 and 2012. Methods: This is a timeseries study of permanent tooth extraction in the state of Minas Gerais. Data were collected in the Brazilian National Health Information System in 2013. Two annual rates of tooth extraction were calculated. The first was the ratio of the extractions of permanent teeth in relation to the total number of individual dental procedures in primary care. The second was the ratio of the number of extractions of permanent teeth divided by the total population. The statistical analysis of the time series was performed. Results: The two extractions rates behaved erratically during the study period. There was a slight tendency to increase in tooth extraction rate via primary care procedures and slight downward trend in tooth extraction rate in Minas Gerais state population. Conclusions: The slightly tendency in increase or decrease of the tooth extraction rates reveal that they remained constant in this period in the state of Minas Gerais.(AU)

A 15-Year Time-series Study of Tooth Extraction in Brazil.

Tooth loss is considered to be a public health problem. Time-series studies that assess the influence of social conditions and access to health services on tooth loss are scarce.This study aimed to examine the time-series of permanent tooth extraction in Brazil between 1998 and 2012 and to compare these series in municipalities with different Human Development Index (HDI) scores and with different access to distinct primary and secondary care.The time-series study was performed between 1998 and 2012, using data from the Brazilian National Health Information System. Time-series study was performed between 1998 and 2012. Two annual rates of tooth extraction were calculated and evaluated separately according to 3 parameters: the HDI, the presence of a Dental Specialty Center, and coverage by Oral Health Teams. The time-series was analyzed using a linear regression model.An overall decrease in the tooth-loss tendencies during this period was observed, particularly in the tooth-extraction rate during primary care procedures. In the municipalities with an HDI that was lower than the median, the average tooth-loss rates were higher than in the municipalities with a higher HDI. The municipalities with lower rates of Oral Health Team coverage also showed lower extraction rates than the municipalities with higher coverage rates.In general, Brazil has shown a decrease in the trend to extract permanent teeth during these 15 years. Increased human development and access to dental services have influenced tooth-extraction rates.

Utilização dos serviços de atendimento odontológico hospitalar sob sedação e/ou anestesia geral por pessoas com necessidades especiais no SUS-MG, Brasil / Availability of hospital dental care services under sedation or general anesthesia for individuals with special needs in the Unified Health System for the State of Minas Gerais (SUS-MG), Brazil

O presente estudo identificou as características demográficas dos indivíduos e assistenciais do tratamento odontológico sob sedação e/ou anestesia geral em ambiente hospitalar no SUS-MG. Foram avaliadas todas as Autorizações de Internações Hospitalares (AIH) para o procedimento Tratamento Odontológico para Pacientes com Necessidades Especiais, de julho de 2011 a junho de 2012. Foram mensuradas variáveis demográficas e assistenciais dos atendimentos. Foram calculadas as taxas de internações por 10.000 habitantes e a cobertura assistencial realizada no estado de Minas Gerais e em cada uma das Regiões Ampliadas de Saúde. A análise descritiva das variáveis foi feita por meio de cálculo da frequência e medidas de tendência central e variabilidade. Foram avaliadas todas as 1.063 AIH pagas no período estudado, que representaram uma taxa de 0,54 internações por 10.000 habitantes. A maioria dos indivíduos era adulta, do sexo masculino, com diagnóstico de transtornos mentais ou comportamentais e residente em 27,7% dos municípios de Minas Gerais. Os procedimentos foram realizados em 39 municípios e a cobertura assistencial foi igual a 1,58%. O estudo revelou um perfil clássico do paciente atendido. Dificuldades em se estabelecer uma rede de atenção à saúde bucal foram identificadas.

This study identified the demographic characteristics of individuals and dental treatment care under sedation/general anesthesia in a hospital environment in the Unified Health System in the State of Minas Gerais (SUS-MG). All Hospitalization Authorizations (AIHs) for Dental Treatment for Patients with Special Needs procedures were evaluated between July 2011 and June 2012. Demographic and health care variables for treatment were also assessed. Hospitalization rates per 10,000 inhabitants, and health care coverage provided in the state of Minas Gerais and in each of the Broader Health Regions were calculated. Descriptive analysis of data was carried out by calculating the central trend and variability frequency and measurements. All 1,063 AIHs paid during the study period were evaluated, which is equivalent to a rate of 0.54 hospitalizations per 10,000 individuals. The majority of the patients were adult, male, diagnosed with mental or behavioral disorders and resident in 27.7% of the municipalities in Minas Gerais. The procedures were performed in 39 municipalities and the care coverage was equal to 1.58%. The study reveals a classic demographic and clinical profile of patient attendance. Difficulties in establishing a network of dental care were identified.

Atribuições dos Técnicos em Saúde Bucal na Estratégia Saúde da Família em Minas Gerais, Brasil / Responsibilities of Oral Health Technician in the Family Health Strategy in Minas Gerais, Brazil

O objetivo deste artigo é analisar o autorrelato de funções executadas pelos Técnicos em Saúde Bucal no Estado de Minas Gerais. Estudo transversal e descritivo, realizado por meio de entrevista telefônica, com amostra representativa de 231 trabalhadores. A análise descritiva envolveu cálculo de proporções. Observou-se que 71,6% (IC 95%, 64,4-77,5) realizavam polimento coronário, 63,2% (IC 95%, 56,1-69,7) faziam raspagem de cálculo e 14,7% (IC 95%, 10,3-20,4) condensavam e inseriam materiais restauradores. Em relação às ações preventivas/coletivas, 100% (IC 95%, 97,6-100,0) participavam de ações educativas, 99,0% (IC 95%, 96,1-99,8) demonstravam técnicas de higiene bucal, 96,6% (IC 95%, 92,7-98,4) realizavam a aplicação tópica de flúor, 77,9% (IC 95%, 71,5-83,3) realizavam visitas domiciliares, e 96,6% (IC 95%, 92,7-98,4) realizavam ações coletivas, principalmente em escolas. Os Técnicos em Saúde Bucal têm desprendido seu tempo mais em atividades preventivas/coletivas do que em atividades assistenciais.

The scope of this article is to analyze the self-reporting of duties performed by the Oral Health Technicians in the State of Minas Gerais. A cross-sectional descriptive study was conducted through telephone interviews, with a representative sample of 231 workers. The descriptive analysis involved the calculation of proportions. It was found that 71.6% (95% CI, 64.4 to 77.5) performed coronal polishing, 63.2% (95% CI, 56.1 to 69.7) carried out scaling of dental calculus and 14.7% (95% CI, 10.3 to 15.4) inserted restorative materials. Regarding preventive/collective actions, 100% (95% CI, 97.6 to 100.0) participated in educational activities, 99% (95% CI, 96.1 to 99.8) demonstrated oral hygiene techniques, 96.6% (95% CI, 92.7 to 98.4) administrated topical fluoride, 77.9% (95% CI, 71.5 to 83.3) made home visits, and 96.6 % (95% CI, 92.7 to 98.4) performed collective actions, especially in schools. Oral Health Technicians have spent their more time on preventive/collective activities than on individual clinical care.

Desigualdades na distribuição da cárie dentária no Brasil: uma abordagem bioética / Inequalities in the distribution of dental caries in Brazil: a bioethical approach

Este artigo objetivou analisar a problemática da cárie dentária, enquanto uma questão de saúde pública de relevância epidemiológica, tendo como suporte analítico a visão da Bioética da Proteção. Trata-se de estudo de caso realizado a partir de análise documental dos inquéritos epidemiológicos em saúde bucal, de base nacional, 1986, 2003 e 2010. Os levantamentos apontam desigualdades entre grupos populacionais. Essa desigualdade foi analisada, com relação à redução da doença na população mais jovem, no acesso ao atendimento, e na perda dentária, pior desfecho para a cárie dentária. Os bons resultados apresentados, nos levantamentos, não atinge toda a população, apresentando desigualdades por renda familiar e região brasileira. Constatou-se a partir de 2003 intervenções do Estado em ações protetoras, como adoção de critérios de equidade na destinação dos recursos na saúde e inclusão de populações em vulneração, contribuindo para redução da cárie. No entanto, considera-se necessário avançar mais nos modelos assistenciais em saúde bucal usando a Epidemiologia como uma ferramenta estruturante, já que as diferenças regionais ainda permaneceram marcantes, em interface com uma bioética protetora e socialmente responsável.

The scope of this paper was to analyze the problem of dental caries as a public health issue of epidemiological relevance. It is a case study based on documentary analysis of national epidemiological surveys on oral health in the years 1986, 2003 and 2010, with the Bioethics of Protection as an analytical support. The surveys revealed inequalities between population groups; and such inequalities were analyzed with respect to the reduction of the disease in the younger population, access to oral health care, and tooth loss, which is the worst outcome for tooth decay. The good results presented in the surveys have not reached the whole population; data have shown inequalities regarding family income and Brazilian region. It was also found that from 2003 government interventions in protective actions such as the adoption of criteria of equity in the allocation of health resources and inclusion of vulnerable population have contributed to a reduction in caries. Nevertheless, it is considered necessary update oral health care models by using Epidemiology as a structuring tool, and an interface with socially responsible protective bioethics, since regional differences continued to be marked in the analysis.

[Inequalities in the distribution of dental caries in Brazil: a bioethical approach]. / Desigualdades na distribuição da cárie dentária no Brasil: uma abordagem bioética.

The scope of this paper was to analyze the problem of dental caries as a public health issue of epidemiological relevance. It is a case study based on documentary analysis of national epidemiological surveys on oral health in the years 1986, 2003 and 2010, with the Bioethics of Protection as an analytical support. The surveys revealed inequalities between population groups; and such inequalities were analyzed with respect to the reduction of the disease in the younger population, access to oral health care, and tooth loss, which is the worst outcome for tooth decay. The good results presented in the surveys have not reached the whole population; data have shown inequalities regarding family income and Brazilian region. It was also found that from 2003 government interventions in protective actions such as the adoption of criteria of equity in the allocation of health resources and inclusion of vulnerable population have contributed to a reduction in caries. Nevertheless, it is considered necessary update oral health care models by using Epidemiology as a structuring tool, and an interface with socially responsible protective bioethics, since regional differences continued to be marked in the analysis.