Self-perception of oral health among tertiary-care users: quanti-qualitative analysis with chronic kidney disease patients

Chronic kidney disease (CKD) has become a global public health challenge. The objective of this study was to analyze the relationship between self-perception of oral health and clinical condition among patients with CKD. This isa quanti-qualitative survey conducted in a CKD specialized service. The sample consisted of 60 patients who underwent oral examinations to have their severity of caries (DMFT) and need for dental prosthesis checked. Age, sex, time on dialysis, marital status, skin color, education and pre-existing diseases were also analyzed. Among the kidney patients who agreed to undergo the clinical examinations and showed communication skills, some were selected, and three focus groups were created, with the participation of a moderator and six to 10 kidney patients in each group. Their speeches were processed in the IRAMUTEQ software and analyzed through the similarity analysis and word cloud techniques. As for profile, the patients were aged 60.23 ± 10.87 years old; were male (73.33%); were on dialysis for 41.90 ± 56.57 months; were married (61.67%); were white (76.67%); had incomplete primary education (41.66%); had arterial hypertension (76.67%); had a DMFT index of 22.55 ± 8.39; 43.33% needed an upper complete denture; and 30.00% needed a lower complete denture. The similarity analysis revealed many doubts and uncertainties about current health services, which can be proven by the words 'no' and 'treatment'. The quanti-qualitative analysis showed a high rate of dental loss and the need for complete dentures and suggests inequities in oral health care for chronic kidney disease patients, especially in tertiary care. There was a positive representation regarding oral health, but the lexicographical analyses of the textual corpusconfirmed the self-perception of lack of dental care.

Characterization of the self-perception of oral health in the Brazilian adult population.

This article aims to perform an analysis of the factors that determine the self-perception of oral health of Brazilians, based on a multidimensional methodology basis. This is a cross-sectional study with data from a national survey. A household interview was conducted with a sample of 60,202 adults. Self-perception of oral health was considered the outcome variable and sociodemographic characteristics, self-care and oral health condition, use of dental services, general health and work condition as independent variables. The dimensionality reduction test was used and the variables that showed a relationship were submitted to logistic regression. The negative oral health condition was related to difficulty feeding, negative evaluation of the last dental appointment, negative self-perception of general health condition, not flossing, upper dental loss, and reason for the last dental appointment. The use of a multidimensional methodological basis was able to design explanatory models for the self-perception of oral health of Brazilian adults, and these results should be considered in the implementation, evaluation, and qualification of the oral health network.

Pre-Natal Monitoring in the Primary Attention of the Brazilian Unified Health System

Objective: To analyze prenatal care in the primary care of the Brazilian Unified Health System. Material and Methods: This is a survey cross sectional research with inquiry-type quantitativequalitative approach. Data collection was performed in 28 cities of the São Paulo state, through on- site observations and interviews with health secretaries, coordinators of primary and oral health care. The following variables were analyzed: Primary health care services for pregnant woman as educational activities, presence of care and referral protocol and the organization of oral health care. Content analysis was performed for the answers of the open questions and the quantitative treatment of the discursive data was obtained through the categorial analysis. For the answers of the closed questions a descriptive analysis was performed. Results: The total number of participants interviewed was 84 managers. It was observed that 78.6 %% of cities carried out educational activities; 42.9% do not have an active care protocol and 57.1% do not have formal referral guidelines to high-risk pregnancies. The rapid tests for HIV, Syphilis, Hepatitis B and C were confirmed by 53.6% of managers and only 39.3% reported evaluating the vaccine situation. As to dental care, 71.4% of the municipalities do not have an established guideline; 46.4% reported that access occurs through spontaneous demand; 32.1% do not consider pregnant woman a priority care group and 67.9% have instituted prenatal dental care. Conclusion: Prenatal care has guaranteed educational activities, but it has deficiencies related to the work process and to the management of services, due, for the most part, to the inexistence of assistance and organizational protocols.

Atuação do cirurgião-dentista no serviço público e o direito à aposentadoria especial / Performance of the dentist in the public service and the right to special retirement

No Brasil, devido ao crescente número de idosos, aumento da longevidade da vida e diminuição da natalidade, novas propostas foram sugeridas para mudanças no requerimento da aposentadoria. O Instituto Nacional do Seguro Social (INSS) é a organização pública brasileira responsável pelos serviços previdenciários. Entretanto, alguns profissionais devido a riscos físicos, biológicos e químicos de sua ocupação, podem requerer uma aposentadoria especial, mediante alguns requisitos determinados por leis. Com isso, o objetivo desta pesquisa foi verificar processos de cirurgiões-dentistas contra o INSS, investigar as principais mudanças propostas para a reforma previdenciárias e suas interferências para estes profissionais. Foi realizada pesquisa transversal, por meio de busca no endereço eletrônico do Tribunal de Justiça do Estado de São Paulo (TJSP): https://esaj.tjsp.jus.br/cjpg/, julgados em 1° grau, no ano de 2016. Para verificar as mudanças propostas com a reforma da previdência foi realizada consulta de leis vigentes no Brasil e material disponibilizado pela previdência social. Foram encontrados 73 processos de cirurgiões-dentistas do serviço público de saúde, destes, 64, 38% foram para requisição da aposentadoria especial e 28,77% foram de aposentados. Do total, 82,19% dos processos obtiveram o parecer procedente. Com relação à reforma da previdenciária, foi visto que a aposentadoria poderá sofrer alterações com relação a idade mínima para obter o benefício. A aposentadoria especial sofrerá algumas alterações no que diz respeito ao recolhimento mensal para a previdência social. Apesar de garantida a aposentadoria especial, alguns cirurgiões-dentistas necessitaram buscar judicialmente este direito. Sobre as mudanças propostas para a reforma previdenciária, algumas poderão levar a prejuízos para os cirurgiões-dentistas.

In Brazil, because of the increasing number of elderly people, increased longevity of life and declining birth rates, new proposals were suggested for changes in the requirement for retirement. The Brazilian National Social Security Institute (INSS) is the public organization responsible for social security services. However, some workers due to the physical, biological and chemical risks of their occupation may require a special retirement, according to some requirements determined by laws. Therefore, the objective of this research was to verify dentists' processes against the INSS, to investigate the main changes proposed for social security reform and their interference for these professionals. A cross-sectional survey was carried out by searching the electronic address of the Court of Justice of the State of São Paulo (TJSP): https://esaj.tjsp.jus.br/cjpg/, judged in 1st degree, in the year of 2016. To verify the changes proposals with the reform of the social security was made consultation of laws in force in Brazil and available material by social security. A total of 73 dentists of the public health service were found, of which 64, 38% went to special retirement and 28.77% were retired. Of the total, 82.19% of the cases obtained the relevant opinion. With regard to the pension reform, it was seen that the retirement may change with respect to the minimum age to obtain the benefit. The special retirement will have some changes as regards the monthly payment for social security. Although special retirement was guaranteed, some dental surgeons needed to apply this right in court. On the proposed changes to the pension reform, some may lead to losses for dentists.

Case-resolving capacity of dental care of the Unified Health System: the perception of users in a city in the state of São Paulo, Brazil.

The aim of this study was to learn about the users' perceptions concerning the case-resolving capacity of dental care in the Unified Health System and to analyze the associations between solving capacity and both sociodemographic characteristics and access to the service. This was a cross-sectional study with a quantitative approach, in which 461 users responded to individual interviews. The outcome variable was the case-resolving capacity of dental care, obtained through the question: "In your opinion, is the dentist of this health center managing to solve all your oral health problems (Yes/No)". Independent variables were grouped into the following: sociodemographic and related to the access to the service. Most participants reported that their oral health problems were being solved. By using the Poisson regression, the lack of case-resolving capacity was found to be associated to the patients' not considering the dental surgeon's working hours convenient; to the long time they had to wait to get an appointment in the health center; and to the long time they had to wait in the waiting room. The results showed the positive view that users have about the case-resolving capacity of public dental care, and the relationship between access to the service and the said solving capacity.

Case-resolving capacity of dental care of the Unified Health System: the perception of users in a city in the state of São Paulo, Brazil / Resolutividade do serviço odontológico no Sistema Único de Saúde: a percepção de usuários de um município paulista, Brasil

Abstract The aim of this study was to learn about the users' perceptions concerning the case-resolving capacity of dental care in the Unified Health System and to analyze the associations between solving capacity and both sociodemographic characteristics and access to the service. This was a cross-sectional study with a quantitative approach, in which 461 users responded to individual interviews. The outcome variable was the case-resolving capacity of dental care, obtained through the question: "In your opinion, is the dentist of this health center managing to solve all your oral health problems (Yes/No)". Independent variables were grouped into the following: sociodemographic and related to the access to the service. Most participants reported that their oral health problems were being solved. By using the Poisson regression, the lack of case-resolving capacity was found to be associated to the patients' not considering the dental surgeon's working hours convenient; to the long time they had to wait to get an appointment in the health center; and to the long time they had to wait in the waiting room. The results showed the positive view that users have about the case-resolving capacity of public dental care, and the relationship between access to the service and the said solving capacity.

Resumo O objetivo neste estudo foi conhecer a percepção do usuário sobre a resolutividade do serviço odontológico no Sistema Único de Saúde, e analisar as associações entre resolutividade e características sociodemográficas e de acesso ao serviço. Tratou-se de uma pesquisa transversal com abordagem quantitativa, na qual 461 usuários responderam a entrevistas individuais. A variável desfecho foi a resolutividade do serviço odontológico, obtida através da seguinte pergunta: "Em sua opinião, o dentista desta unidade de saúde está conseguindo resolver todos os seus problemas de saúde bucal? (sim/não)". As variáveis independentes foram agrupadas em: sociodemográficas, e de acesso ao serviço. A maioria dos participantes relatou que seus problemas de saúde bucal estavam sendo resolvidos. Por meio da regressão de Poisson, observou-se que a falta de resolutividade esteve associada a não considerar o horário de trabalho do cirurgião-dentista conveniente; à grande demora para conseguir realizar o agendamento para a unidade de saúde; e ao tempo na sala de espera ser muito demorado. Os resultados revelaram a percepção positiva que o usuário teve sobre a resolutividade do serviço público odontológico, e a relação existente entre o acesso ao serviço e a capacidade resolutiva referida.

Inequalities in Oral Health among Older Brazilians: A Cross-Sectional Analysis of a National Survey

Objective: To investigate the association of tooth loss and periodontal disease with socioeconomic and demographic factors, the need for and use of health services, and the effect of oral health on the daily lives of older Brazilians. Material and Methods: We abstracted data from a nation-wide, representative, cross-sectional survey of 7619 Brazilians aged between 65 to 74 years. Poisson regression models were created to investigate associations between oral diseases and income, education level, gender, ethnicity, region of residence, and use of dental services; statistical significance was set at 5%. Results: The mean age of the 7619 subjects studied was 69 years (95% Confidence Interval, 68.9­69.1); 61.9% were women. Regarding ethnicity, 46.95% were White, 38.90% were Brown, 11.54% were Black and 2.53% belonged to other ethnic groups. Bleeding on probing or dental calculus was present in 26.67% of subjects, whereas LOA was present in 87.27%. The loss of at least one tooth was observed in 48.90% of subjects, while 47.03% were completely edentulous. Low educational status increased the prevalence ratio (PR) of all diseases (loss of attachment, PR=5.54; bleeding on probing, PR=3.93; tooth loss, PR=2.24; edentulousness, PR=3.34). The prevalence of tooth loss was 2.58 times higher in subjects who reported a monthly income of less than 301 USD. The effect on daily life was occasionally a protective factor and occasionally increased the likelihoods of diseases. Conclusion: These findings substantiate the association of socioeconomic conditions, demographic features, and use of dental services with bleeding on probing, presence of dental calculus, loss of periodontal attachment, tooth loss, and edentulousness among older Brazilian subjects.

Análise documental dos serviços de saúde bucal ofertados à população indígena no brasil / Documentary analysis of the oral health services offered to the brazilian indigenous population

Introdução: Os povos indígenas do Brasil compõem um cenário diversificado do ponto de vista cultural. A garantia de assistência à saúde geral e bucal indígena, atualmente, foi estabelecida pelo Subsistema de Atenção à Saúde Indígena, integrado ao Sistema Único de Saúde. Objetivos: Analisar a política de saúde bucal inserida no subsistema de saúde indígena, evidenciando a sua evolução no processo histórico e legal. Metodologia: Trata-se de um estudo descritivo e exploratório, em que foram consultados decretos, leis e portarias, já com as recentes e respectivas mudanças na legislação. Discussão: Apesar dos avanços, há recorrentes disparidades ao analisarmos a saúde bucal indígena em comparação à população brasileira não indígena. Essa diferença é observada nos perfis de saúde indígena, os quais são relativos aos âmbitos nacionais e regionais, em uma combinação de fatores socioeconômicos, ambientais e políticos. Ao longo do tempo, a saúde indígena esteve sob responsabilidade de distintas instituições. Recentemente, um projeto de lei propôs a criação do Instituto Nacional de Saúde Indígena, com intuito de simplificar os processos administrativos. Conclusão: A trajetória da saúde bucal indígena brasileira é marcada por dissidências e existem bases jurídicas que garantem o acesso aos cuidados de saúde deste grupo, embora a descontinuidade das políticas impeça a integralidade das ações de saúde bucal (AU).

Introducion: From a cultural point of view the Brazilian indigenous peoples compose a diversified cultural scenario. The guarantee of general and oral health assistance of indigenous people has been established by the Subsystem of Attention to Indigenous Health, integrated into the Brazilian Unified Health System. Objectives: To analyze the oral health policy inserted in the subsystem of indigenous health, evidencing its evolution in the historical and legal process. Methodology: It was a descriptive and exploratory study, in which decrees, laws and rules were consulted, with recent and relevant changes in legislation. Discussion: Despite the advances there are recurrent disparities when analyzing indigenous oral health in comparison to the nonindigenous Brazilian population. This difference is observed in indigenous health profiles, which are related to national and regional levels, in a combination of socioeconomic, environmental and political factors. Over the years, indigenous health has been under the responsibility of different institutions. Recently, a bill proposed the creation of the National Institute of Indigenous Health, in order to simplify administrative processes. Conclusion: The trajectory of Brazilian indigenous oral health is marked by dissidents and there are legal bases that guarantee the access to health care of this group, although the discontinuity of the policies blocks the integrality of oral health actions (AU).

Determinants of oral self-care in the Brazilian adult population: a national cross-sectional study.

This study aims to investigate variables related to adherence to oral self-care in the Brazilian adult population. It is an exploratory study, using secondary data from a population-based survey on a representative sample of the adult population of the entire Brazilian territory (n=60202). The sample was selected using a multiple stage approach. The oral self-care indicator was defined by grouping the variables: periodicity of dentist appointments, use of dental floss, toothbrush and toothpaste, frequency of brushing and replacement of the toothbrush. The scores obtained from the indicator were categorized into adequate, partially adequate, and inadequate care. Statistical analysis consisted of dimensionality reduction, and oral self-care-related variables were submitted to logistic regression. The variables mostly related to inadequate or partially adequate oral self-care were: illiteracy (OR = 11.20, OR = 4.81), low educational level (OR = 3.50, OR = 1.96), negative oral health self-concept (OR=3.73, OR=1.74), absence of natural teeth (OR = 4.98, OR=2.60), edentulous lower arch (OR = 3.09; _____), number of missing upper teeth (OR=1.14, OR=1.05), absence of health insurance (OR=2.23, OR=2.07), sedentary lifestyle (OR=2.77, OR=1.51), and smoking (OR=2.18, OR=1.40). It was concluded that the individual's level of education is one of the main factors for adherence to adequate oral self-care, followed by level of oral health self-concept and tooth loss. Likewise, lifestyle also bears a significant influence.

Evaluación comparativa del conocimiento sobre salud oral entre equipos pedagógicos que recibieron y no recibieron promoción en salud / Comparative evaluation of oral health knowledge among pedagogical teams receiving and not receiving health promotion

Este estudio tuvo como objetivo evaluar, comparativamente, las diferencias en el conocimiento sobre salud oral de equipos pedagógicos que recibieron y que no recibieron el Programa de Salud Oral, promovido por la Facultad de Odontología de Araçatuba (FOA), en las escuelas de enseñanza infantil del municipio de Araçatuba, São Paulo, Brasil. Participaron de esta investigación transversal 76 profesores de 10 escuelas municipales de enseñanza infantil (EMEB). Los equipos pedagógicos del grupo experimental recibieron las actividades del Programa de Salud Oral de la FOA (n=38); en cambio, los equipos establecidos en el grupo de control no las recibieron (n=37). Se recolectaron los datos por medio de un cuestionario que trazaba el perfil del profesor (sexo, función en la escuela, edad, nivel de escolaridad) y evaluaba su conocimiento sobre salud oral (placa dental, caries dental, cepillo de dientes, almacenamiento de cepillos, dentífrico, chupete, hábitos de higiene oral). Se compararon las variables independientes entre los grupos por medio de tests estadísticos. El 76,6 % de la muestra eran de profesores de enseñanza infantil y solo uno era del sexo masculino. La media de edad de los dos grupos fue de 41 años y el grado de escolaridad fue de posgrado completo (88,1 %). La investigación identificó comportamiento muy semejante en las respuestas del cuestionario en ambos los grupos encuestados, siendo sus respuestas muy cerca a las del sentido común. Esta investigación concluye que no hay diferencias significativas en el conocimiento sobre salud oral entre los grupos evaluados.

This study's goal was to comparatively evaluate the differences between the oral health knowledge of two teaching staff groups: those that were part of the oral health promotion programs and those that were not. Seventy six (76) teachers at ten nursery schools participated in this transversal study. The teaching staff of the intervention group were part of the activities of the "Oral Health Promotion Program in state-funded nursery schools of Araçatuba, São Paulo State" of the Araçatuba Dental School (Faculdade de Odontologia de Araçatuba - FOA/UNESP) (n=38), however, the teachers from the control group were not part of the activities (n=37). The data were collected through questionnaire with the goal of identifying the educator (sex; function at the school; age; years of schooling), and to evaluate the educator's knowledge regarding oral health (dental plaque, dental caries, toothbrush, storage of toothbrushes, tooth paste, pacifier, oral hygiene habits). The independent variables were compared between the groups through statistical tests. 76.6 % of the sample was of teachers of the nursery schools and only one participant was male. The average age between both groups was 41 and the average education level was of graduation (88.1 %). The research identified a very similar behavior in the questionnaire answers from both groups, and the knowledge identified on the evaluation was close to common sense. This study concluded that there were not significant differences on the oral health knowledge between the evaluated groups.

Eleven years of monitoring fluoride content in public water supplies: methods, products, and importance to public health / Onze anos de vigilância dos teores de flúor nas águas de abastecimento público: métodos, produtos e importância para a saúde pública

This study aimed to assay the development process and the characteristics of a program in uninterrupted activity for over 11 years, which monitors fluoride content in public water supplies, emphasizing the methodology used in the research, the services provided to cities and specificities of water distribution networks, the products derived from project implementation, the main results obtained in its course, and its importance in favor of public health. Monitoring is necessary to reach the maximum benefit in the prevention of tooth decay and minimum risk in fluorosis development. To develop the study, documents and reports of the project's database and the results of water samples were analyzed. A survey of the intellectual productions generated by the project was performed, maps of water distribution networks of 40 cities in the northwest region of São Paulo state included in the project were analyzed, and the research methodology was presented. The activities carried out in the project have been described with details regarding the main methodological aspects, such as the form of establishment of sample collection points, the laboratory methodology used for the analysis of water samples, the extension experience the project offers to all parties involved, the results of 11 years of sample analyses, the benefits generated to health managers and those responsible for water treatment, among other considerations on the cities. The methodology adopted by the project allows identifying areas where the population may be exposed to higher fluoride concentrations. From November 2004 to December 2015, 50.98% of water samples from all cities were within the optimal parameters.

O objetivo deste estudo foi analisar o processo de desenvolvimento e as características de um programa em atividade ininterrupta há mais de 11 anos, que realiza o monitoramento do nível de flúor nas águas de abastecimento público, enfatizando a metodologia utilizada na pesquisa; os serviços prestados para as cidades e as especificidades das redes de distribuição de água; produtos gerados com a implementação do projeto; os principais resultados obtidos em seu curso; e sua importância em favor da saúde pública. A vigilância do método é necessária para se alcançar o máximo benefício na prevenção da cárie dentária e mínimo risco no desenvolvimento de fluorose. Para o desenvolvimento do estudo, foram feitas análises documentais e de relatórios do banco de dados do projeto e os resultados das amostras de água. Foi realizado um levantamento das produções intelectuais que o projeto gerou, a análise dos mapas de redes de distribuição de água das 40 cidades do noroeste do estado de São Paulo incluídas no projeto, e apresentação da metodologia de pesquisa. As atividades desenvolvidas no projeto foram descritas com detalhes quanto aos principais aspectos metodológicos, tais como: a forma de estabelecimento de pontos de coleta das amostras; a metodologia laboratorial utilizada para a análise de amostras de água; a experiência extensionista que o projeto oferece a todas as partes envolvidas; os resultados de 11 anos de análise das amostras; os benefícios gerados para os gestores de saúde e os responsáveis pelo tratamento de água; entre outras considerações sobre as cidades. A metodologia adotada pelo projeto permite a identificação de áreas onde a população pode estar exposta a altas concentrações de flúor. De novembro de 2004 a dezembro de 2015, 50,98% das amostras de água de todas as cidades estavam dentro dos parâmetros ideais.

Longitudinal study into the determining factors of dental caries in children aged 4: socio-behavioral aspects and oral health of pregnant women / Estudo longitudinal sobre determinantes da cárie aos 4 anos de idade: aspectos sócio-comportamentais e saúde bucal da gestante

ABSTRACT Objective: To analyze the influence of oral health conditions and socio-behavioral characteristics of pregnant women on the development of caries and their children's experiences, after 4 years of follow-up. Methods: It was conducted a longitudinal study of mother/child pairs by interview and oral clinical examination during pregnancy. Regular observations were made until the child had reached four years of age, at which time we performed a clinical examination of the children (n=73). The variables studied were: presence of caries in pregnancy (DMFT) and the child (deft), visit to the dentist, oral hygiene habits, diet, socioeconomic and behavioral factors, and were related to two study outcomes: presence of caries during the examination and experience of caries (deft≥1) in children of 4 years of age. Bivariate and logistic regression analyses were conducted with the variables (p<0.05 and 95% CI). Results: The average DMFT index of mothers during pregnancy was 12.09 (±2.88) and average deft index of children at 4 years was 1.79 (± 6.1). In the multiple logistic regression analysis, the presence of caries in children was associated with the presence of harmful habits (p=0.04). Caries in the child was statistically associated with brush sharing among family members (p=0.02). Conclusion: The results suggest that behavioral aspects are related to the presence and experience of caries in childhood.

RESUMO Objetivo: Analisar a influência das condições de saúde bucal e das características sócio-comportamentais de gestantes no desenvolvimento e na experiência de cárie em seus filhos, após 4 anos de acompanhamento. Métodos: Foi realizado um estudo longitudinal com pares de mães e filhos, mediante entrevista e exame clínico bucal na gestação. Observações periódicas foram realizadas até os quatro anos completos de idade da criança, momento em que foi realizado o exame clínico na criança (n=73). As variáveis estudadas foram: presença de cárie na gestante (CPOD) e na criança (ceod), visita ao cirurgião-dentista, hábitos de higiene bucal, dieta, fatores socioeconômicos e comportamentais, sendo relacionadas com dois desfechos do estudo: presença de cárie no momento do exame e experiência de cárie (ceod≥1) em crianças aos 4 anos de idade. Foram conduzidas análises bivariadas e multivariada com auxílio do Programa Bioestat (p<0,05 e IC 95%). Resultados: O CPOD médio das mães durante a gestação foi 12,09 (±2,88) e ceod médio das crianças aos 4 anos foi 1,79 (±6,1). Na análise de regressão logística múltipla, a presença de cárie nos filhos esteve associada com a presença de hábitos deletérios (p=0,04). A experiência de cárie no filho foi associada estatisticamente com o compartilhamento de escova entre os membros da família (p=0.02). Conclusão: Os resultados sugerem que aspectos comportamentais estão relacionados à presença e experiência de cárie na infância.

User Satisfaction with the Public Oral Health Services in the Different Dimensions of Health Care

Objective: To verify user satisfaction with the public oral health services in its different dimensions of care and relate them to the socioeconomic and demographic conditions. Material and Methods: Cross-sectional survey, developed with users interviewed of the public oral health services under the Primary Health Care of a Brazilian city (n=461). The associations of satisfaction with the socioeconomic and demographic conditions were analyzed using the chi-square test. Questions concerning satisfaction with the service were grouped into five domains - 'physical structure', 'relation and communication', 'information and support', 'health care' and 'organization of services' - analyzed using the Kruskal-Wallis Test. Results: Elderly individuals with low education and male, tended to be more satisfied with the services. The users reported being satisfied with the service, that were unhappy, referred to the time and the form to schedule a consultation, the time expected to be attended and the resolving capacity of oral health problems, as the causes. The overall satisfaction index was 0.8. The top rated domains were 'physical structure' (0.9) and 'relation and communication' (0.85). The 'service organization' domain received the worst evaluation (0.71) and when compared to the others domain presenting a significant difference. The 'physical structure' domain was significantly highlighted from the domains of 'oral health care' (0.78) and 'information and support' (0.78). The 'relation and communication' domain, also significantly excelled over the areas of 'oral health care'. Conclusion: The users rated the aspects of health care in a very positive way. The areas of highest user satisfaction were 'physical structure' and 'relation and communication'. However, the need for directing production processes in health became evident, especially regarding the organization of services, the domain with the worst rating.

[User evaluation on dental care in the Unified Health System: an approach from the standpoint of humanization]. / Avaliação do usuário sobre o atendimento odontológico no Sistema Único de Saúde: uma abordagem à luz da humanização.

The scope of this study was to assess user evaluation about dental care in the Unified Health System and analyze the associations between this evaluation, sociodemographic characteristics, and aspects related to humanization of the services. It involved a cross-sectional survey with a quantitative approach, in which 461 users responded to individual interviews. The outcome variable was obtained by means of the question: "How do you consider the care given by the dentist and by the team in this health unit?" Responses were grouped into "positive evaluation" and "negative evaluation." The independent variables integrated two groups: sociodemographic, and related to the humanization of care. The positive evaluation (90.4%) prevailed over the negative. Using Poisson regression, it was found that the negative evaluation was statistically associated with not having felt confidence in the dentist and staff, and not being able to talk to these professionals after the end of treatment. The results showed the preponderantly positive user evaluation of the service, and suggest that the evaluation may be more related to the humanization in services than to sociodemographic characteristics of the population.

Demand organization in public oral health services: analysis of a traditional model / Organização da demanda em serviços públicos de saúde bucal: análise de um modelo tradicional

ABSTRACT Objective: To discuss the municipal experience of the organization and the demand for dental services, based on the guidelines of the Unified Health System (UHS), which point to the structuring of an assistance model based on universality and integrality of care and equity in access to services. Methods: The research, realized in Araçatuba/SP, was based on documentary analysis and interviews with key-informants of the UHS dental service. The traditional court model has a care system for schoolchildren and a basic network with priority for pregnant women. Results: In total, the network has 59 dental surgeons, 31 oral health auxiliaries and 17 Oral Health Teams; however, the school attendance model persists, with 10 professionals attending public schools. Based on the discussions, it is concluded that there are no established criteria for the organization of demand. Conclusion: Most of the attendance occurs by free demand, and the reference and counter-referral system is incipient, damaging the service's resoluteness.

RESUMO Objetivo: Discutir a experiência municipal da organização a demanda de serviços odontológicos, com base nas diretrizes do Sistema Único de Saúde (SUS), as quais apontam para a estruturação de um modelo assistencial com base na universalidade e na integralidade da atenção e na equidade no acesso aos serviços. Métodos: A pesquisa, realizada em Araçatuba (SP), teve como base a análise documental e entrevistas com informantes-chave do serviço odontológico do SUS. O modelo de corte tradicional, conta com um sistema de assistência para escolares e uma rede básica com prioridade para gestantes. Resultados: No total, a rede conta com 59 cirurgiões-dentistas, 31 auxiliares em saúde bucal e 17 Equipes de Saúde Bucal, entretanto persiste o modelo de atendimento a escolar, com 10 profissionais atendendo em escolas públicas. A partir das discussões colocadas, conclui-se que, não há critérios estabelecidos para organização da demanda. Conclusão: A maioria dos atendimentos ocorre por livre demanda, e o sistema de referência e contra-referência é incipiente, prejudicando a resolutividade do serviço.

Oral health assessment from the perspective of the municipal manager / Avaliação da saúde bucal na ótica do gestor municipal

ABSTRACT Objective: The aim of this study was to conduct a situational diagnosis related to the organization of oral health services in 40 municipalities of São Paulo State, Brazil. Methods: This is a cross-sectional, quantitative and qualitative, descriptive study performed through document analysis and application of a semi-structured questionnaire to oral health coordinators, in 2014. The following items were defined: dental infrastructure, access and regulation, work organization and assessment strategies. Although the Basic Health Unit is the main gateway to the system, dental care was also conducted in schools; the main service access of the population was the spontaneous demand and there have been production data inconsistencies in the information systems. Results: It was observed that, 60% answered that the health planning process included oral health; 47.5% performed risk assessment; 47.5% did not perform evaluation and monitoring of results. Conclusion: It is concluded that municipalities present different moments in the structuring of the service and that managers should improve the access organization, the work process and service evaluation in order to consolidate the universality and comprehensiveness of health care.

RESUMO Objetivo: Realizar um diagnóstico situacional relacionado à organização dos serviços de saúde bucal de 40 municípios do Estado de São Paulo, Brasil. Métodos: Trata-se de um estudo transversal, quanti-qualitativo, descritivo, realizado em 2014, por meio de análise documental e aplicação de um questionário semiestruturado nos coordenadores de saúde bucal. As seguintes dimensões foram definidas: infraestrutura odontológica, acesso e regulação, organização do processo de trabalho e estratégias de avaliação. Apesar da Unidade Básica de Saúde ser a principal porta de entrada para o Sistema, o atendimento odontológico ainda era realizado em escolas; a principal forma de acesso da população aos serviços foi a demanda espontânea e havia inconsistências nos dados de produção nos sistemas de informações. Resultados: Do total, 60% responderam que o processo de planejamento em saúde envolveu a área de saúde bucal; 47,5% realizavam avaliação de risco; 47,5% não realizavam avaliação e o acompanhamento dos resultados alcançados. Conclusão: Conclui-se que os municípios apresentam diferentes momentos na estruturação do serviço e que os gestores devem aprimorar a organização do acesso, do processo de trabalho e da avaliação dos serviços para a consolidação da universalidade e integralidade da atenção em saúde.

Considerações de profissionais e usuários sobre o serviço público odontológico: um aporte para o planejamento em saúde / Professional and users considerations on the public dental service: subsidies to health planning

Este estudo tem como objetivo verificar a percepção de profissionais e usuários acerca da necessidade de melhorias no serviço público odontológico. Trata-se de uma pesquisa qualitativa desenvolvida junto a usuários do serviço odontológico (n=240), profissionais da saúde bucal (n=51) e agentes comunitários da saúde (n=126). Os dados foram coletados por meio de entrevista individual e tratados pela Técnica de Análise de Conteúdo. Os resultados mostram que os diferentes sujeitos indicaram a necessidade das seguintes melhorias: estrutura física; sistema de agendamento de consultas; tempo de espera e filas para o atendimento e número de atendimentos diários. Observou-se também, a falta de humanização, de acolhimento e a baixa cobertura da atenção odontológica. Conclui-se que os resultados apontaram para ajustes efetivos nos campos da infraestrutura, recursos materiais e organização dos serviços. Sugere-se que os mesmos sejam considerados em um projeto de implantação da gestão compartilhada das ações e serviços de saúde bucal no âmbito da Atenção Primária à Saúde no Brasil.

The aim is verify the perception of professionals and users about the need for improvements in public dental services. Qualitative research was conducted with users of dental service (n=240), oral health professionals (n=51) and community health workers (n=126). Data were collected through individual interviews and processed by the Content Analysis Technique. The results shows the different subjects indicated the need for the following improvements: physical structure; appointment scheduling system; waiting time and queues for the service and number of daily calls. There was also a lack of humanization, the host and the low coverage of dental care. Concludes that the results showed necessary adjustments in the fields of infrastructure, material resources and services organization. It is suggested that they are considered in a deployment project of the shared management of stock and oral health services within the primary health care in Brazil.

Avaliação do usuário sobre o atendimento odontológico no Sistema Único de Saúde: uma abordagem à luz da humanização / User evaluation on dental care in the Unified Health System: an approach from the standpoint of humanization

Resumo Objetivou-se neste estudo conhecer a avaliação do usuário sobre o atendimento odontológico no Sistema Único de Saúde e analisar as associações entre a mesma, características sociodemográficas e aspectos relacionados à humanização nos serviços. Trata-se de pesquisa transversal com abordagem quantitativa, na qual 461 usuários responderam a entrevistas individuais. A variável desfecho foi obtida por meio da pergunta: “Como o(a) Senhor(a) considera o atendimento dado pelo dentista e pela equipe dele nessa unidade de saúde?”. As respostas foram agrupadas nas categorias “avaliação positiva” e “avaliação negativa”. As variáveis independentes integraram dois grupos: sociodemográficas e relacionadas à humanização no atendimento. A avaliação positiva (90,4%) prevaleceu sobre a negativa. Utilizando-se a regressão de Poisson, verificou-se que a avaliação negativa esteve estatisticamente associada a não ter sentido confiança no dentista e na equipe, e a não ter facilidade para falar com esses profissionais após o fim do tratamento. Os resultados evidenciaram a preponderante avaliação positiva do usuário sobre o atendimento, e sugerem que a avaliação pode estar mais relacionada à humanização nos serviços do que às características sociodemográficas da população.

Abstract The scope of this study was to assess user evaluation about dental care in the Unified Health System and analyze the associations between this evaluation, sociodemographic characteristics, and aspects related to humanization of the services. It involved a cross-sectional survey with a quantitative approach, in which 461 users responded to individual interviews. The outcome variable was obtained by means of the question: “How do you consider the care given by the dentist and by the team in this health unit?” Responses were grouped into “positive evaluation” and “negative evaluation.” The independent variables integrated two groups: sociodemographic, and related to the humanization of care. The positive evaluation (90.4%) prevailed over the negative. Using Poisson regression, it was found that the negative evaluation was statistically associated with not having felt confidence in the dentist and staff, and not being able to talk to these professionals after the end of treatment. The results showed the preponderantly positive user evaluation of the service, and suggest that the evaluation may be more related to the humanization in services than to sociodemographic characteristics of the population.

Oral health assessment protocol in primary care / Protocolo de Avaliação da Saúde Bucal na Atenção Básica

Objective: The aim of this study was to analyze the oral health service performance in a certain municipality and also to develop a diagnostic evaluation protocol of Oral Health in Primary Care. Methods: This is a descriptive, quantitative and qualitative research. The research site chosen was in the city of Pereira Barreto, State of São Paulo Brazil, since it makes use of the Family Health Strategy as the structuring care model of the Health Care System in 100% of the population as well as oral health teams implemented and oral health secondary care. Data were obtained through interviews with the manager, six dentists, six oral health assistants and six community health workers. Document analysis of the Municipal Health Plan was also conducted along with the Dental Health Agenda and on-site observation of the dental structure. Results: The city Health Plan presents a detailed description of the municipality general situation, the oral health agenda recommends, in its implementation phase, the three main areas as a core in Family Health Strategy as follows: health unit, family and community.The survey found that the main form of access of the population to services was the spontaneous demand and there were only two Family Health teams without focus on oral health. Conclusion: The analysis of the service performed; made possible to develop a protocol with specific Oral Health dimensions to support the manager in defining intervention strategies.

Objetivo: Analisar o funcionamento do serviço de Saúde Bucal em um município e desenvolver um protocolo de avaliação diagnóstica da Saúde Bucal na Atenção Básica. Métodos: Trata-se de uma pesquisa quanti-qualitativa, descritiva. O local da pesquisa foi Pereira Barreto, São Paulo, por apresentar a Estratégia Saúde da Família como modelo assistencial estruturante do Sistema de Atenção à Saúde em 100% da população; equipes de saúde bucal implantadas; atenção secundária em saúde bucal. Os dados foram obtidos por meio de entrevistas com o gestor, 6 cirurgiões-dentistas, 6 auxiliares de saúde bucal e 6 agentes comunitários de saúde. Foram realizadas também análise documental do Plano Municipal de Saúde, Agenda de Saúde Bucal e observação in loco da estrutura odontológica. Resultados: O município oferta serviços de saúde bucal com integração entre atenção básica e especializada, sendo a atenção básica ordenadora da rede. O Plano Municipal de Saúde apresenta descrição detalhada da situação geral do município; a agenda de saúde bucal preconizada em fase de implantação contempla os três eixos de atuação da Estratégia Saúde da Família: unidade de saúde, família e comunidade. O inquérito identificou que a principal forma de acesso da população aos serviços era a demanda espontânea; havia duas equipes de Saúde da Família sem equipes de Saúde bucal. Conclusão: A análise do funcionamento do serviço possibilitou desenvolver um protocolo com dimensões específicas de Saúde Bucal para subsidiar o gestor na definição de estratégias de intervenção.

Relationship betweenPerception of Oral Health, Clinical Conditions and Socio-Behavioral Factors of Mother-Child

To verify a mother's perception about her and her child`s oral health as well as to analyze its association with socio-behavioral factors.Material and Methods:The study was conducted with 73 pairs of mother and child, through interviews, using a semi-structured questionnaire and clinical exam. The clinical variables studied were: caries prevalence and gingival diseases and nonclinical variables: socio-behavioral factors, perception and habits.Bivariate analyzes, logistic regression and odds ratio (p ≤ 0.05 and 95% CI) were employed.Results:Most mothers considered their oral health as poor (57.5%) and their children as good (68.5%). In the multivariate analysis, measures of self-perception of oral health were significantly associated with the presence of caries in the mother (p <0.01), and oral health perception of the child was related to the presence of caries (p <0.01) and marital status (0.05).Conclusion:The clinical and behavioral factors were associated with themeasures of perceived oral health...