Cost-related variables in the public purchase of dental materials for endodontic application: 10-year analysis

Aim: This study analyzed public procurements for different endodontic materials used in the Brazilian public health system and evaluated the variables related to their cost. Methods: A time-series study was performed by screening materials for endodontic application in the public Brazilian Databank of Healthcare Prices from 2010 to 2019. Data were categorized according to material composition and clinical application. The collated variables were used in a multiple linear regression model to predict the impact of unit price in procurement processes. Results: A total of 5,973 procurement processes (1,524,693 items) were evaluated. Calcium hydroxides were found in 79% of the observations (4,669 processes). Prices drop each year by US$1.87 while MTAs and epoxy resins are increasingly purchased at higher prices (US$50.87; US$67.69, respectively). The microregion, the procurement modality, and the type of institution had no influence on unit prices in the adjusted model (p > 0.05). Conclusions: Calcium hydroxide-based materials were the cheapest and most frequently purchased endodontic materials in the public health care system. Novel formulations are being implemented into clinical practice over time and their cost may be a barrier to the broad application of materials such as MTAs, despite their effectiveness

Race in public health dentistry: a critical review of the literature.

OBJECTIVE: To carry out a critical review of the literature on the use of race, color, and ethnicity in the field of public health dentistry. METHODS: A literature search was conducted in MEDLINE via PubMed for articles published between 2014 and 2019. Using a data extraction form, we collected information on (1) bibliographic characteristics of the selected papers; (2) race, color, and ethnicity of the study participants and their sociodemographic profiles; and (3) the extent to which the original publications followed the recommendations by Kaplan and Bennett (2003) on the use of race, color, or ethnicity in biomedical research. RESULTS: Our initial search identified 2,032 articles, 53 of which were selected for full-text examination and assessment following pre-established eligibility criteria. Around 60% (n = 32) of the included studies did not justify the use of race, color, or ethnicity in their analyses, and 9% (n = 5) took these variables as indicators of the participants' genetic makeup. On the other hand, 68% (n = 36) of the reviewed papers considered race, color, and ethnicity as risk markers - not risk factors - for adverse oral health outcomes, whereas 80% (n = 42) adjusted racial/ethnic inequities for a range of socioeconomic and demographic factors in statistical models. Only one study (2%) explicitly took race, color, or ethnicity as a contextually dependent dimension of the participants' identities. CONCLUSION: Our findings indicate that research on oral health inequities is often based on reductionist and stigmatizing conceptions of race, color, or ethnicity. Such harmful misconceptions should be replaced with anti-racist narratives in order to effectively address racial oral health inequities.

Os desafios e as potencialidades da saúde bucal na Estratégia Saúde da Família: uma análise dos processos de trabalho / Challenges and potentialities of oral health in the Family Health Strategy: an analysis of work processes

Resumo A saúde bucal foi inserida no Programa Saúde da Família por meio da Portaria do Ministério da Saúde nº 1.444/2000, mas somente após a publicação da Política Nacional de Saúde Bucal houve uma reorganização das práticas e ações em saúde bucal. O objetivo deste estudo foi identificar os principais desafios e potencialidades dos processos de trabalho em saúde bucal no âmbito da Estratégia Saúde da Família. Trata-se de uma pesquisa de abordagem qualitativa realizada com as Equipes de Saúde Bucal e a Coordenação de Saúde Bucal do município de Coreaú, Ceará, Brasil, totalizando 11 participantes. A coleta das informações ocorreu entre abril e agosto de 2019, a partir de grupo focal, diário de campo e entrevista semiestruturada. Utilizou-se a Análise de Conteúdo de Bardin, sendo realizadas triangulação e interpretação das informações definidas em cinco categorias: organização do processo de trabalho; educação em saúde; interprofissionalidade e prática colaborativa; gestão participativa e satisfação dos usuários. Concluiu-se que, no processo de trabalho, a maior problemática é a marcação dos atendimentos em saúde bucal. As potencialidades identificadas foram a inserção da Odontologia na Estratégia Saúde da Família e a integração da equipe de saúde bucal com o efetivo interesse de transformação das práticas.

Abstract Oral health was included in the Family Health Program through Ministry of Health Ordinance No. 1444/2000, but only after the publication of the National Oral Health Policy was there a reorganization of oral health practices and actions. This study aimed to identify the main challenges and potential of the oral health work processes within the scope of the Family Health Strategy. This research has a qualitative approach carried out with the Oral Health and Oral Health Coordination Teams in the municipality of Coreaú, Ceará, Brazil, totaling 11 participants. Information was collected between April and August 2019 from a focus group, field diary and semi-structured interviews. Bardin's Content Analysis was used, with triangulation and interpretation of the information defined in five categories: organization of the work process; health education; inter-professionality and collaborative practice; participatory management and user satisfaction. It was concluded that in the work process the biggest problem is the scheduling of oral health care. The potentialities identified were the insertion of Dentistry in the Family Health Strategy and the integration of the oral health team with the effective interest in transforming practices.

Race in public health dentistry: a critical review of the literature

ABSTRACT OBJECTIVE To carry out a critical review of the literature on the use of race, color, and ethnicity in the field of public health dentistry. METHODS A literature search was conducted in MEDLINE via PubMed for articles published between 2014 and 2019. Using a data extraction form, we collected information on (1) bibliographic characteristics of the selected papers; (2) race, color, and ethnicity of the study participants and their sociodemographic profiles; and (3) the extent to which the original publications followed the recommendations by Kaplan and Bennett (2003) on the use of race, color, or ethnicity in biomedical research. RESULTS Our initial search identified 2,032 articles, 53 of which were selected for full-text examination and assessment following pre-established eligibility criteria. Around 60% (n = 32) of the included studies did not justify the use of race, color, or ethnicity in their analyses, and 9% (n = 5) took these variables as indicators of the participants' genetic makeup. On the other hand, 68% (n = 36) of the reviewed papers considered race, color, and ethnicity as risk markers - not risk factors - for adverse oral health outcomes, whereas 80% (n = 42) adjusted racial/ethnic inequities for a range of socioeconomic and demographic factors in statistical models. Only one study (2%) explicitly took race, color, or ethnicity as a contextually dependent dimension of the participants' identities. CONCLUSION Our findings indicate that research on oral health inequities is often based on reductionist and stigmatizing conceptions of race, color, or ethnicity. Such harmful misconceptions should be replaced with anti-racist narratives in order to effectively address racial oral health inequities.

Conocimientos, percepciones y actitudes de estudiantes y pasantes de odontología mexicanos con relación al COVID-19: Estudio descriptivo / Knowledge, perceptions and attitudes in Mexican dental students and interns related with COVID-19: A descriptive study

La enfermedad de COVID-19 es causada por el nuevo coronavirus SARS-CoV-2 (síndrome respiratorio agudo severo), convertida hoy en día en una pandemia, emergencia sanitaria y crisis de salud pública. El propósito de este estudio fue evaluar el conocimiento, la percepción y actitudes frente a dicha pandemia de en los estudiantes y pasantes de odontología. Material y métodos: Investigación cuantitativa con diseño transversal, descriptivo y exploratorio. El tamaño de la muestra fue de 167 participantes a través de encuestas en línea, donde se describieron sus actitudes, conocimiento y percepción, por medio de un cuestionario de autorreporte el cual consistió de 24 ítems relacionados con la comprensión de la COVID-19. Resultados: La mayoría de los discípulos tiene un entendimiento moderado en relación con la normatividad, y su competencia, en su entorno con dicho trastorno viral, es adecuada. La mayoría (89.5%) respondieron tener actitudes adecuadas con el manejo del control de infecciones y prevenciones. En cuestión a la percepción, la mayoría (82.4%) sí tenía medidas de prevención a fin de evitar la transmisión y medicación adecuadas. Conclusión: Estos estudiantes están conscientes de la COVID-19 y sus medidas de prevención y precaución, requieren adquirir mayores saberes de normas sanitarias, así como llevar estrictos protocolos de control de infecciones para garantizar el ambiente seguro a los alumnos y pacientes que acuden a las clínicas odontológicas (AU)

The COVID-19 disease is caused by the new coronavirus SARS-CoV-2, which today has become a pandemic, health emergency, and public health crisis. The purpose of this study was to evaluate the knowledge, perception and attitudes towards such pandemic in dental students and interns. Material and methods: Quantitative research with a crosssectional, descriptive and exploratory design. The sample size was 167 participants through online surveys, where attitudes, knowledge and perception were described, through a self-report questionnaire which consisted of 24 items related to their knowledge of this malaise. Results: The majority of study participants have a moderate knowledge in relation to the normativity, and the knowledge of the disease in their environment is adequate. The majority (89.5%) responded having adequate attitudes with the management of infection control and prevention. Regarding perception, the majority (82.4%) did have adequate medication and preventive measures to avoid transmission. Conclusion: These students are aware of the COVID-19 sickness and its prevention and precaution measures and they require acquiring greater knowledge of health regulations as well as carrying out strict infection control protocols to guarantee a safe environment for students and patients who attend dental clinics (AU)

Um olhar sobre a saúde bucal de pacientes acamados domiciliados cadastrados em unidades da Estratégia Saúde da Família no município de Teresópolis/RJ / A perspective on the oral health of home care bedridden patients registered in ESF units in the city of Teresópolis/RJ

Resumo Saúde bucal deficiente pode interferir na saúde geral do indivíduo acamado, prolongando o tempo de recuperação ou agravando a enfermidade. Nesse contexto, esse estudo teve o objetivo de identificar os problemas de saúde bucal percebidos por cuidadores e pacientes acamados domiciliados cadastrados em unidades da ESF no município de Teresópolis, região serrana do Estado do Rio de janeiro. Realizou-se um estudo exploratório baseado em entrevistas. Os principais problemas de saúde bucal referidos foram a dor de dente, a cárie dental, os dentes permanentes perdidos, as lesões na mucosa e a doença periodontal. Esses resultados ajudam a compreender a real demanda de serviços odontológicos possibilitando oferecer um atendimento que respeite as prioridades dos indivíduos. Tais achados apontam para a necessidade de um maior suporte por parte da equipe de saúde para essas famílias. Existe a necessidade de atividades de educação em saúde bucal para o paciente e seu cuidador, orientação quanto a higiene oral, identificação de lesões orais e tratamento clínico.

Abstract Poor oral health may interfere with the general health of the bedridden subject, prolonging recovery time or aggravating the disease. In this context, this study aimed to identify oral health problems perceived by caregivers and home care bedridden patients registered in ESF units in the city of Teresópolis, located in the mountainous region of the state of Rio de Janeiro. An exploratory study based on interviews was conducted. The main referred oral health problems were toothache, dental caries, lost permanent teeth, mucosal lesions and periodontal disease. These results help to understand the demand for dental services, making it possible to provide a service that respects the individual's priorities. These findings point to the need for greater support from the health team for these families. There is a need for oral health education activities for the patient and their caregiver, guidance on oral hygiene, identification of oral lesions and clinical treatment.

Can Teledentistry Improve the Monitoring of Patients during the Covid-19 Dissemination? A Descriptive Pilot Study.

The aim of this pilot study was to describe the advantages of telemedicine (TM) in dental practice during the current national emergency condition due to the Covid-19 dissemination. At Department of Oral Surgery and Pathology-Magna Graecia University of Catanzaro, regional reference center for Covid-19-two groups of patients were determined: patients with urgent conditions (group U) and patients in follow-up (group F). Both groups were instructed to implement remote consultations using a messaging service (WhatsApp Messenger, WhatsApp Inc., Mountain View, California, USA) to send photos. A total of 418 photos were collected by 57 patients. Thirty-four photos were obtained by five patients in the U group after surgical procedures. All patients sent photos on the established evening, except for two patients who sent two photos outside the set days. In the F group, 384 photos were collected by 52 patients. None of them sent more photos than the number that was established by the protocol. Telemedicine allowed a monitoring of all patients, reducing costs and limiting human contact, decreasing the risk of Covid-19 dissemination.

Implementation of public health genomics and applications to public health dentistry.

National and state public health genomics efforts exist to effectively and responsibly translate genome-based knowledge to improve population health and reduce health disparities. Over the past two decades, public health genomics efforts have utilized the core public health functions of assessment, policy development, and assurance. Current evidence for a small number of genomic applications suggests that many lives could be saved if these were implemented in recommended populations. With the drastic increase in new genetic tests and technologies, multidisciplinary public health genomics efforts that should include public health dentistry are of greater importance. There is a need to integrate public health dentistry in efforts to increase use of evidence-based genomic tests and services to improve health outcomes. Additionally, public health genomic efforts also are utilized to promote awareness about the insufficient evidence of the validity, utility and ethical, legal, and social implications for the vast majority of genomic tests. This is demonstrated by a recent genetic testing policy statement and educational resources from the American Dental Association. These organizational efforts should be considered in other realms of public health genomics to ensure that only genetic tests and preventive services with sufficient evidence for use are being implemented in clinical and public health.

Presença de Centros de Especialidades Odontológicas e sua relação com a realização de exodontias na rede de atenção de saúde bucal no Brasil / Presence of Specialized Dentistry Centers and the relationship with dental extractions in the oral healthcare network in Brazil / Presencia de Centros de Especialidades Odontológicas y su relación con la realización de exodoncias en la red de atención de salud bucal en Brasil

Resumo: Objetivou-se avaliar a associação entre presença de Centros de Especialidades Odontológicas (CEO) e a proporção de exodontias em relação ao total de procedimentos odontológicos em serviços públicos do Brasil. Trata-se de um estudo ecológico, em que foram avaliados dados sociodemográficos, dos serviços de saúde bucal e produção ambulatorial de 5.333 municípios nos biênios de 2000/2001 e 2015/2016. A principal variável de exposição foi a presença de CEO, e o desfecho a média nacional da proporção de exodontias em relação ao número de procedimentos odontológicos preventivos e curativos. Foram realizadas análises de interação e regressão múltipla usando modelo binomial com função de ligação logito. A média nacional da proporção de exodontias em relação aos procedimentos odontológicos preventivos e curativos foi 27,07% e 15,11% em 2000/2001 e 2015/2016, respectivamente. Na análise de interação entre a presença de CEO e a cobertura superior a 80% de equipes de saúde bucal (ESB), houve menores proporções de exodontias em relação aos procedimentos odontológicos preventivos e curativos (OR = 0,71; IC95%: 0,71-0,72). Na análise de regressão múltipla, municípios com Índice de Desenvolvimento Humano entre 0,6-0,7 (OR = 0,77; IC95%: 0,77-0,77), Produto Interno Bruto per capita maior que 20 mil Reais (OR = 0,45; IC95%: 0,45-045) e maior população residente em zona urbana (OR = 0,72; IC95%: 0,72-0,72) apresentaram menor proporção de exodontias em relação aos procedimentos odontológicos preventivos e curativos em 2015/2016. Conclui-se que ocorreram menores proporções de exodontias em relação aos procedimentos odontológicos preventivos e curativos em municípios com ao menos um CEO e com mais de 80% de cobertura de ESB, o que aponta que municípios com Rede de Atenção à Saúde Bucal consolidada têm melhor desempenho na oferta de cuidados odontológicos.

Abstract: This study aimed to assess the association between the presence of Specialized Dentistry Centers and dental extractions as a proportion of all dental procedures in public services in Brazil. This was an ecological study that assessed sociodemographic data, oral health services, and outpatient production in 5,333 municipalities in 2000-2001 and 2015-2016. The principal exposure variable was the presence of Specialized Dentistry Centers, and the outcome was the mean national proportion of dental extractions in relation to all preventive and curative dental procedures. Interaction and multiple regression analyses were performed using a binomial model with log link function. The mean national proportions of dental extractions in relation to preventive and curative dental procedures were 27.07% and 15.11% in 2000-2001 and 2015-2016, respectively. In the analysis of interaction between the presence of Specialized Dentistry Centers and coverage greater than 80% by the oral health teams, there were lower proportions of dental extractions in relation to preventive and curative dental procedures (OR = 0.71; 95%CI: 0.71-0.72). In the multiple regression analysis, municipalities with Human Development Index of 0.6-0.7 (OR = 0.77; 95%CI: 0.77-0.77), annual per capita GDP greater than BRL 20,000 (OR = 0.45; 95%CI: 0.45-045), and proportionally higher urban populations (OR = 0.72; 95%CI: 0.72-0.72) showed fewer dental extractions as a proportion of all preventive and curative dental procedures in 2015-2016. In conclusion, there were lower proportions of tooth extractions in municipalities with at least one Specialized Dentistry Center and with a coverage of greater than 80% by the oral health teams, highlighting that municipalities with a consolidated Oral Health Care Network present better performance in the supply of dental care.

Resumen: Este trabajo tuvo el objetivo de evaluar la asociación entre la presencia de Centros de Especialidades Odontológicas (CEO) y su proporción de exodoncias, en relación con el total de procedimientos odontológicos en los servicios públicos de Brasil. Se trata de un estudio ecológico, en que se evaluaron datos sociodemográficos, servicios de salud bucal y atención ambulatoria en 5.333 municipios, durante los bienios de 2000/2001 y 2015/2016. La principal variable de exposición fue la presencia de CEO y el resultado la media nacional de la proporción de exodoncias, respecto al número de procedimientos odontológicos preventivos y curativos. Se realizó tanto un análisis de interacción, como de regresión múltiple, usando un modelo binomial con función de vinculación logit. La media nacional de la proporción de exodoncias, en relación con los procedimientos odontológicos preventivos y curativos, fue 27,07% y 15,11% en 2000/2001 y 2015/2016, respectivamente. En el análisis de interacción entre la presencia de CEO y la cobertura superior a un 80% de equipos de salud bucal (ESB) hubo menores proporciones de exodoncias, en relación con los procedimientos odontológicos preventivos y curativos (OR = 0,71; IC95%: 0,71-0,72). En el análisis de regresión múltiple, los municipios con un Índice de Desarrollo Humano entre 0,6-0,7 (OR = 0,77; IC95%: 0,77-0,77), PIB per cápita mayor que BRL 20.000 (OR = 0,45; IC95%: 0,45-045) y mayor población residente en zona urbana (OR = 0,72; IC95%: 0,72-0,72) presentaron una menor proporción de exodoncias, respecto a los procedimientos odontológicos preventivos y curativos en 2015/2016. Se concluye que hubo menores proporciones de exodoncias, en lo que respecta a los procedimientos odontológicos preventivos y curativos en municipios con al menos un CEO, y con más de un 80% de cobertura de ESB, lo que apunta a que los municipios con una Red de Atención a la Salud Bucal consolidada tienen un mejor desempeño en la oferta de cuidados odontológicos.

The implementation of a decision-tree did not increase decision-making in patients with temporomandibular disorders in the public dental health service.

OBJECTIVE: Many patients with temporomandibular disorders (TMD) seem to go undetected within primary dental health care. Primarily we evaluated if the implemented intervention increased the clinical decision-making for TMD patients; secondarily we evaluated if other factors could be identified that predicted performed or recommended TMD treatment. MATERIAL AND METHODS: This case-control study was carried out within the Public Dental Health service in Västerbotten County, Sweden. An intervention based on a decision-tree with three screening questions for TMD (3Q/TMD) was implemented during 2015 in four clinics and compared with the remaining county. A total of 400 individuals were selected-200 3Q-positives and 200 3Q-negatives. The 3Q/TMD consists of Q1-frequent jaw pain, Q2-frequent pain on function, and Q3-frequent catching and/or locking of jaw. The 3Q/TMD answers were analyzed in relation to TMD treatment and any TMD related decision that was collected from the digital dental records. RESULTS: The intervention did not increase the frequencies of traceable clinical decisions among patients with TMD. CONCLUSIONS: Despite the implemented intervention aimed, the indicated undertreatment of patients with TMD remains. Future studies are still needed to gain a deeper understanding of the clinical decision-making process for TMD patients in general practice dentistry.

[Presence of Specialized Dentistry Centers and the relationship with dental extractions in the oral healthcare network in Brazil]. / Presença de Centros de Especialidades Odontológicas e sua relação com a realização de exodontias na rede de atenção de saúde bucal no Brasil.

This study aimed to assess the association between the presence of Specialized Dentistry Centers and dental extractions as a proportion of all dental procedures in public services in Brazil. This was an ecological study that assessed sociodemographic data, oral health services, and outpatient production in 5,333 municipalities in 2000-2001 and 2015-2016. The principal exposure variable was the presence of Specialized Dentistry Centers, and the outcome was the mean national proportion of dental extractions in relation to all preventive and curative dental procedures. Interaction and multiple regression analyses were performed using a binomial model with log link function. The mean national proportions of dental extractions in relation to preventive and curative dental procedures were 27.07% and 15.11% in 2000-2001 and 2015-2016, respectively. In the analysis of interaction between the presence of Specialized Dentistry Centers and coverage greater than 80% by the oral health teams, there were lower proportions of dental extractions in relation to preventive and curative dental procedures (OR = 0.71; 95%CI: 0.71-0.72). In the multiple regression analysis, municipalities with Human Development Index of 0.6-0.7 (OR = 0.77; 95%CI: 0.77-0.77), annual per capita GDP greater than BRL 20,000 (OR = 0.45; 95%CI: 0.45-045), and proportionally higher urban populations (OR = 0.72; 95%CI: 0.72-0.72) showed fewer dental extractions as a proportion of all preventive and curative dental procedures in 2015-2016. In conclusion, there were lower proportions of tooth extractions in municipalities with at least one Specialized Dentistry Center and with a coverage of greater than 80% by the oral health teams, highlighting that municipalities with a consolidated Oral Health Care Network present better performance in the supply of dental care.

Objetivou-se avaliar a associação entre presença de Centros de Especialidades Odontológicas (CEO) e a proporção de exodontias em relação ao total de procedimentos odontológicos em serviços públicos do Brasil. Trata-se de um estudo ecológico, em que foram avaliados dados sociodemográficos, dos serviços de saúde bucal e produção ambulatorial de 5.333 municípios nos biênios de 2000/2001 e 2015/2016. A principal variável de exposição foi a presença de CEO, e o desfecho a média nacional da proporção de exodontias em relação ao número de procedimentos odontológicos preventivos e curativos. Foram realizadas análises de interação e regressão múltipla usando modelo binomial com função de ligação logito. A média nacional da proporção de exodontias em relação aos procedimentos odontológicos preventivos e curativos foi 27,07% e 15,11% em 2000/2001 e 2015/2016, respectivamente. Na análise de interação entre a presença de CEO e a cobertura superior a 80% de equipes de saúde bucal (ESB), houve menores proporções de exodontias em relação aos procedimentos odontológicos preventivos e curativos (OR = 0,71; IC95%: 0,71-0,72). Na análise de regressão múltipla, municípios com Índice de Desenvolvimento Humano entre 0,6-0,7 (OR = 0,77; IC95%: 0,77-0,77), Produto Interno Bruto per capita maior que 20 mil Reais (OR = 0,45; IC95%: 0,45-045) e maior população residente em zona urbana (OR = 0,72; IC95%: 0,72-0,72) apresentaram menor proporção de exodontias em relação aos procedimentos odontológicos preventivos e curativos em 2015/2016. Conclui-se que ocorreram menores proporções de exodontias em relação aos procedimentos odontológicos preventivos e curativos em municípios com ao menos um CEO e com mais de 80% de cobertura de ESB, o que aponta que municípios com Rede de Atenção à Saúde Bucal consolidada têm melhor desempenho na oferta de cuidados odontológicos.

Este trabajo tuvo el objetivo de evaluar la asociación entre la presencia de Centros de Especialidades Odontológicas (CEO) y su proporción de exodoncias, en relación con el total de procedimientos odontológicos en los servicios públicos de Brasil. Se trata de un estudio ecológico, en que se evaluaron datos sociodemográficos, servicios de salud bucal y atención ambulatoria en 5.333 municipios, durante los bienios de 2000/2001 y 2015/2016. La principal variable de exposición fue la presencia de CEO y el resultado la media nacional de la proporción de exodoncias, respecto al número de procedimientos odontológicos preventivos y curativos. Se realizó tanto un análisis de interacción, como de regresión múltiple, usando un modelo binomial con función de vinculación logit. La media nacional de la proporción de exodoncias, en relación con los procedimientos odontológicos preventivos y curativos, fue 27,07% y 15,11% en 2000/2001 y 2015/2016, respectivamente. En el análisis de interacción entre la presencia de CEO y la cobertura superior a un 80% de equipos de salud bucal (ESB) hubo menores proporciones de exodoncias, en relación con los procedimientos odontológicos preventivos y curativos (OR = 0,71; IC95%: 0,71-0,72). En el análisis de regresión múltiple, los municipios con un Índice de Desarrollo Humano entre 0,6-0,7 (OR = 0,77; IC95%: 0,77-0,77), PIB per cápita mayor que BRL 20.000 (OR = 0,45; IC95%: 0,45-045) y mayor población residente en zona urbana (OR = 0,72; IC95%: 0,72-0,72) presentaron una menor proporción de exodoncias, respecto a los procedimientos odontológicos preventivos y curativos en 2015/2016. Se concluye que hubo menores proporciones de exodoncias, en lo que respecta a los procedimientos odontológicos preventivos y curativos en municipios con al menos un CEO, y con más de un 80% de cobertura de ESB, lo que apunta a que los municipios con una Red de Atención a la Salud Bucal consolidada tienen un mejor desempeño en la oferta de cuidados odontológicos.

Mediaciones efectuadas en el ámbito odontológico realizadas por el sistema público de salud. 2010-2015 / Mediations in dentistry made by the public health system. 2010-2015

RESUMEN: Introducción: La Reforma de Salud del 2005 estableció la mediación como un procedimiento obligatorio para la justicia civil, con el objeto de evitar la judicialización de la salud. Esta investigación ahonda en las características de las mediaciones odontológicas del sistema público de salud en Chile. Material y Método: Estudio transversal, de mediaciones generadas por atenciones odontológicas otorgadas en el sistema público de salud entre los años 2005 y 2015 informadas por Unidad de Mediación del Consejo de Defensa del Estado (CDE). Resultados: No se dispone de anterior al año 2010 por falta de registro. Por tanto, solo fue factible analizar desde 2010 al 2015. Se registran 127 mediaciones ingresadas odontológicas, el 61% reclamantes son mujeres. 60,6% proviene de la atención secundaria. 83,4% (106 casos) el reclamo es contra el establecimiento y el tratante. Sólo el 22% logra acuerdo. De estos, el 10% solo requiere explicaciones y solo el 28,5% solicita indemnización. Conclusiones: Una mejor relación profesional-paciente disminuye el riesgo de judicialización, así como una mejor difusión del procedimiento de mediación aumentaría tasa de acuerdos.

ABSTRACT: Introduction: The 2005 Health Reform established mediation as a mandatory procedure for civil justice, in order to avoid prosecution of health. This research delves into the characteristics of the dental mediations of the Chilean public health system. Material and method: Cross-sectional study of mediations generated by dental care granted in the public health system between 2005 and 2015, reported by the Mediation Unit of the State Defense Council (CDE). Results: Not available prior to 2010 due to the lack of registration. Therefore, an analysis was only feasible from 2010 to 2015. There are 127 dentistry mediations registered, 61% of the claimants are women. 60.6% come from secondary care. 83.4% (106 cases) the claim is against the establishment and the practitioner. Only 22% achieve agreement. Of these, 10% only require explanations and only 28.5% ask for compensation. Conclusions: A better professional-patient relationship reduces the risk of prosecution, and a better dissemination of the mediation procedure would increase agreement rate.

Dental Public Health Practice, Infrastructure, and Workforce in the United States.

Dental public health is a unique specialty of dentistry that focuses on prevention of oral diseases among populations rather than individual patients. It encompasses several complementary disciplines and greatly varies in its functions and activities. Several federal, state, local, and nonpublic entities operationalize the mission of dental public health to improve population oral health through a diverse and vibrant workforce.

Infant Oral Health: An Emerging Dental Public Health Measure.

Infant oral health (IOH) is a preventive service advocated by major medical and dental organizations. IOH aims to prevent early childhood caries (ECC) and impart health strategies to families for continued oral health and prevention of future caries. IOH reaches across disciplines, is low cost, and is covered by Medicaid and many private dental payers. Increasing evidence points to immediate and long-term positive oral health outcomes of reduced disease, reduction in costly care, and reduction in ECC-associated morbidities.

A Public Health Perspective on Paying for Dentistry, the Affordable Care Act, and Looking to the Future.

Health care costs have traditionally been provider generated whereas payment has been split between public and private sources. There has been little pressure on health care providers to demonstrate value. The quest for value in health care financing is now widely evident as demonstrated by governmental and private sector pursuits of a 3-part aim: better health outcomes at lower cost with improved patient and population experience. Value-based approaches involve payment innovation with its attendant constraints and opportunities for innovation. This contribution posits a growing role for dental public health by exploring interfaces with these forces within the contexts of US dental care financing.

Clinical Analysis of Management Aspects of Centers for Dental Specialties

Objective: To evaluate the different management aspects of Centers for Dental Specialties (CEO) in Brazil. Material and Methods: Quantitative study with analysis of secondary data. The results of external evaluation of the first PMAQ-CEO cycle were considered, especially those related to planning and self-assessment, demand organization, work process, human resources as well as the availability of supplies/materials/dental equipment. The selected data were analyzed based on the calculation of proportions using the Microsoft Office Excel and Statistical Package for the Social Sciences (SPSS) programs. Results: The planning of actions in CEOs is conducted in nearly 80% of units, with the participation of dental surgeons, receiving support, mainly, from the local dental health or state public manager. The access to CEO is given, mostly, in a referenced or mixed (referenced and spontaneous) form. Only 49% of CEOs offer permanent education actions for workers. The work management process has been guided by quality standards of PMAQ-CEO for 77% of managers. Conclusion: The study allowed perceiving the presence of an often shared management, on the CEO organization, on self-evaluation process, planning, demand organization and work process, as well as human resources and infrastructure, showing conformity with the Oral Health National Policy guidelines. However, the results show that some problems with regard to the evaluation as work routine and management of access to CEOs still persist, pointing to the need for further studies and effort of managers to overcome them.

The Graduating European Dentist-Domain IV: Dentistry in Society.

This position paper outlines the areas of competence and learning outcomes of "The Graduating European Dentist" that specifically relates to Dentistry in Society. In addition to treating individual patients, a Dentist must be able to focus on promoting health, monitoring interventions and implementing effective strategies of care at community and population levels. This necessarily involves understanding population demography and health trends, engaging with health policy and promoting health. A Dentist must also understand population demography and health trends, in the context of the healthcare system within which they work.

Salud bucodental y utilización de servicios Odontológicos / Oral health and dental health service use

En el Paraguay, los datos epidemiológicos sobre la salud bucodental y la utilización de los servicios en adultos son limitados, de ahí, la urgente necesidad de generar información para diseñar y establecer programas de salud pública acordes a las necesidades de dicha población. El objetivo de este estudio transversal retrospectivo fue determinar la situación de salud bucodental y el patrón de utilización de los servicios odontológicos de los pacientes atendidos en las cátedras de Operatoria Dental II y III de la carrera de Odontología de la Universidad Católica-Campus de Itapúa. La muestra incluyó 411 historias clínicas odontológicas de pacientes atendidos entre 2014 y 2017. La edad promedio de los pacientes fue de 28 años. La prevalencia de caries fue del 94,6%. El Índice de dientes cariados, perdidos y obturados promedio fue de 13,2 (DE± 6,9), siendo el mayor componente el de dientes cariados (7,0±4,5), seguido por el de dientes perdidos (4,4±5,7). Un alto porcentaje (77%) de los pacientes no tenía seguro médico al momento de consultar. El motivo de consulta actual del 42% fue la estética y el 64% sólo consulta al dentista cuando necesita. El valor promedio del índice de dientes cariados, perdidos y obturados (13,2) es catalogado como grave. El predominio de los componentes dientes cariados y perdidos es indicativo de un limitado acceso a los servicios odontológicos y tratamientos restauradores. Se requiere la instauración de estrategias de promoción de la salud y prevención de las afecciones bucodentales enmarcadas dentro de programas desde el primer nivel de atención.

In Paraguay, epidemiological data on the oral health situation and the use of dental care services by adult are limited, hence the urgent need to generate relevant information to design and establish public health programs in accordance with the needs of the population. The objective of this cross-sectional retrospective study was to determine the oral health situation and the pattern of utilization of the dental services of the patients treated in the Dental Operatory Chairs II and III of the Odontology program at the Catholic University-Campus of Itapúa. The sample consisted of 411 clinical records of patients treated between 2014 and 2017. The average age of patients was 28 years. The prevalence of caries was 94.6%. The index of decayed, missing and filled teeth was 13.2 (±6.9). The largest component was decayed teeth (7.0±4.5), followed by teeth lost (4.4±5.7). A high percentage (77%) of patients did not have health insurance at the time of consultation. The main reason for current consultation was aesthetics (42%) and 64% of participants only attends dentist when needed. The average index of decayed, missing and filled teeth (13.2) is classified as severe. The predominance of decayed and missing teeth components is indicative of limited access to the use of dental services and restorative treatments. It is necessary to establish strategies for health promotion and prevention of oral diseases as part of the programs from the first care level.

Accountable Care Organizations and Oral Health Accountability.

Accountable care organizations agree to be accountable for the cost and outcomes of an attributed population. However, in many, no provisions have been made to account for oral health. There are several social, medical, and financial implications for health care provider and payer systems and health care outcomes when oral health is not accounted for in patient management. How can an organization strive to improve population health without including the oral health system? Total systemic health for a population must include oral health. Accountable care organizations are positioned to change the course of oral health in the United States and close the disparities that exist among vulnerable populations, including seniors. Such efforts will reduce health care costs. Opportunities abound to expand points of entry into the health care system via dental or medical care. Closing the great divide between 2 historically isolated professions will position the United States to make gains in true population health. I provide evidence of the need to mandate access to oral health care services for all Americans-specifically adults, because legislation currently exists for pediatric dental coverage.

Using Registered Dental Hygienists to Promote a School-Based Approach to Dental Public Health.

We examine a strategy for improving oral health in the United States by focusing on low-income children in school-based settings. Vulnerable children often experience cultural, social, economic, structural, and geographic barriers when trying to access dental services in traditional dental office settings. These disparities have been discussed for more than a decade in multiple US Department of Health and Human Services publications. One solution is to revise dental practice acts to allow registered dental hygienists increased scope of services, expanded public health delivery opportunities, and decreased dentist supervision. We provide examples of how federally qualified health centers have implemented successful school-based dental models within the parameters of two state policies that allow registered dental hygienists varying levels of dentist supervision. Changes to dental practice acts at the state level allowing registered dental hygienists to practice with limited supervision in community settings, such as schools, may provide vulnerable populations greater access to screening and preventive services. We derive our recommendations from expert opinion.