Contextual inequalities in specialized dental public health care in Brazil

Abstract The present study aimed to investigate the contextual inequalities of specialized public dental care (SPDC) in Brazil. The outcome was the trajectory of dental specialized production in municipalities with SPDC (from 2015 to 2017) obtained by group-based trajectory modeling. A Poisson regression model was used to analyze the factors associated with the high trajectory of SPDC production. The inequality indicators for SPDC production were the slope index and the concentration index according to contextual factors. The study included 954 SPDC units distributed across 893 municipalities. Among the municipalities evaluated, 62.9% had a low trajectory of SPDC. Large-sized municipalities had the highest production (IRR = 2.84, 95%CI: 1.94-4.14) and the southern region had the lowest production (IRR = 0.73, 95%CI: 0.58-0.92). Municipalities presenting a very high human development index (HDI) showed the greatest SPDC production (IRR = 3.34, 95%CI: 1.09-10.24), as well as municipalities with the highest tertile of schooling rate (IRR = 1.23, 95%CI: 1.00-1.50). The absolute inequality was 52.1 percentage points for the average monthly wage (p < 0.001), 61.0 percentage points for the HDI (p < 0.001), -22.1 for infant mortality rate (p <0.001), and 14.8 for the schooling rate (p = 0.012). Thus, there are contextual inequalities in the Brazilian SPDC. Higher scores for social indicators were associated with better SPDC performance.

Can oral health have an impact on academic performance and school absenteeism?: a systematic review and meta-analysis

Aim: The study aimed to evaluate the association between oral health and academic performance and/or school absenteeism. Methods: Electronic searches were performed of the PubMed, Web of Science, SCOPUS and LILACS/BVS databases. We included observational studies that evaluated the association between dental caries, tooth loss, dental pain or oral health status with school absenteeism or academic performance. The studies had to contain a representative sample of the population: schoolchildren, children or adolescents. After the removal of duplicates, the electronic searches produced 3,789 articles. Of these, 25 studies were included in the systematic review and 13 in the meta-analysis. Results: Considering all the studies evaluated in the meta-analysis, seven articles satisfied 100% of the Joanna Briggs Institute Critical Appraisal checklist, and six contained between 90% and 75% positive answers. The pooled effects showed that the chances of school absenteeism were 31% higher in subjects with dental caries (OR 1.31; 95%CI 1.12-1.54). Students with fair/poor dental health had a 50% higher chance of suffering poor academic performance (OR 1.50; 95%CI 1.22-1.84) and 34% higher chance of having problems at school (OR 1.34; 95%CI 1.06-1.70). Students with a history of toothache had a 3.7 higher chance of being absent from school (OR 6.65; 95%CI 1.60-8.32) and 71% higher chance of missing class due to toothache (OR 1.71; 95%CI 1.15-2.56). Subjects with a history of toothache had a 2.5 times higher chance of suffering poor academic performance (OR 2.58; 95% CI 2.04-3.27). Conclusion: Therefore, students with oral problems were more likely to take time off school and present inferior academic performance

Human venous blood derivatives as fetal bovine serum substitute for fibroblast culture cells in a fibrin construct

Aim: Venous blood derivatives (VBDs) have been suggested as substitutes for Fetal Bovine Serum (FBS) to improve the clinical transition of cell-based therapies. The literature is not clear about which is the best VBDs substitute. The present study aimed to evaluate the influence of VBDs on cell viability and describe a new method to seed these cells in a 3D Platelet-Rich Fibrin (PRF). Methods: Blood was processed to obtain Platelet-Poor Plasma from PRF (P-PRF), Human Serum (HS), Platelet-Poor Plasma from PRP (P-PRP), activated-PRP (a-PRP), and Platelet lysate (PL). Cells were supplemented with each VBD at 10% and FBS at 10% was the control. Cell viability (fibroblast 3T3/NIH) test was evaluated with MTT assay in two ways: i) cell-seeded and expanded with VBD; ii) cell-seed with FBS and expanded with VBD. To seed the Fibrin construct, cells were suspended in PBS and dropped into the blood sample before performing Choukroun's protocol for PRF. Constructs were cultured for 7 days in VBD supplements and FBS. Histological and Immunohistochemical analysis with vimentin was performed. Cell viability was analyzed by one-way ANOVA. Results: VBD's production time was very heterogeneous. Cells expanded in HS and a-PRP has grown faster. VBD-supplemented culture media provided cell culture highly sensible to trypsin/EDTA 0.25%. Cells seeded and expanded with VBD presented viability comparable to FBS in HS, a-PRP, and P-PRP (p>0.05) and lower in P-PRF and PL groups (p<0.05). The viability of cell seed with FBS and expanded with VBD was similar between P-PRF, a-PRP, PL, and FBS (p>0.05) and lower in HS and P-PRP (p<0.005). PRF-seeded cells showed a positive expression of vimentin and were able to maintain all cells supplemented with VBD. Conclusion: VBD supplements were able to maintain fibroblast cells in 2D and 3D cultures. The new method of the fibrin-cell construct was efficient to insert the cells into the fibrin network

Socioeconomic status in life course is associated with dental appearance dissatisfaction

Abstract The present study aimed to investigate the prevalence of dissatisfaction with dental appearance among 24-year-old Brazilian adults and the associated factors in life course. A subsample (n = 720) of the 1982 Pelotas Birth Cohort in southern Brazil was investigated at the ages of 15 and 24 years using clinical (caries and periodontal) examinations and interviews. The outcome was dissatisfaction with dental appearance at the age of 24 years. Covariate variables included socioeconomic factors, oral health, and dissatisfaction with general appearance collected during different periods of life. Poisson regression models with robust variance were applied. The prevalence of dissatisfaction with dental appearance was 43.5% (95%CI: 39.8-47.1). Individuals with downward income mobility (PR = 1.22, 95%CI: 1.07-1.79) and those always poor (PR = 1.21, 95%CI: 1.00-1.57) presented a higher prevalence of dissatisfaction with their dental appearance even after oral health variables and dissatisfaction with general appearance were controlled for. Moderate/severe malocclusion at 15 years (PR = 1.34, 95%CI: 1.13-1.59), highest experience of untreated dental caries at 24 years (PR = 1.82, 95%CI: 1.46-2.27), and dental pain experience at 24 years (PR = 1.29, 95%CI: 1.22-1.75) were associated with the outcome. Also, the prevalence of dissatisfaction with dental appearance was 20% higher (PR = 1.20, 95%CI: 1.01-1.43) among those dissatisfied with their general appearance. Our findings demonstrated a high prevalence of dissatisfaction with dental appearance among young adults. Lifetime economic disadvantage and dental problems (malocclusion at 15 years, untreated dental caries at 24 years, and dental pain at 24 years) were associated with dissatisfaction with dental appearance among young adults.

Dental students' self-perception of security and biosafety measures in times of pandemic by COVID-19: a cross-sectional study in private Universities in Southern Brazil

The study investigated the factors associated with the self-perception safety of dental students in clinical activities during the COVID-19 pandemic. This cross-sectional study was based on a semi-structured online (google forms) self-applied questionnaire, sent by e-mail to three private Dental Schools in Brazil. The variables were: 1) sociodemographic information; 2) questions about the measures adopted by dental schools before returning to clinical activities; 3) dental students' self-perception of security; 4) the General Health Questionnaire. Data were submitted to Fisher's exact test (p<0.05). Of the 294 eligible students, 97% were evaluated and 100% received previous specific biosafety training predominantly theoretical (72.16%) longer than one hour (51.55%). Most students (81.44%) felt secure performing clinical care during the COVID-19 pandemic. Students undergoing specific biosafety training for longer than one hour felt safer than those perfoming training for up to 1 hour (p=0.004). Students from schools where the aerosol-producing restriction was applied felt safer than those without restrictions (p=0.016). Women reported feeling less secure than men (p=0.046), and students who submitted to COVID-19 Specific Biosafety Training felt safer in clinical activities than those submitted to theoretical training only (p=0.011). Students from private universities presenting psychosomatic changes felt less secure in practicing clinical dental care activities (p=0.006). In conclusion, time-spent training in biosafety, restriction of the use of aerosol-producing procedures, and the gender of students were associated with the self-perception safety of students. Students with practical training felt safer in clinical activities for patients with COVID-19 than those who had only theoretical training

Analysis of dentistry content on Instagram®and the use of social networks by Brazilian dental students

Aim: The aim of our study was to analyze the content related to dentistry published on Instagram® and to investigate the students' profiles related to the use of social networks in a sample from a Dentistry School. Methods: This study was carried out in two stages. First, research was conducted to analyze content published on Instagram® related to dentistry. The second part investigated the profiles of students' from a dental school in relation to the use of social networks through a questionnaire. A descriptive analysis was performed and associations between the variables were tested using Fisher's exact test. Results: We found a diversified and large amount of content related to dentistry published on Instagram®, and publications that involved advertising were more prevalent in our study. There are also many publications that are violating the Code of Dental Ethics. In addition, in the second part of our study, we observed an enormous use of social networks by dental students (98.4%). Conclusions: As a result, we believe that it is important to update professionals about the ethical infractions related to social networks which could be approached during graduate courses in universities. Finally, the analyzed social network seems to be an interesting alternative for disseminating health information in order to dialogue with greater proximity to the large number of users who participate in it

Flipped classroom and the use of role-play in the COVID-19 pandemic: challenges and learning

Aim In Brazil, COVID-19 remains one of the epicenters of the pandemic, thus, presential educational activities are suspended. The study aimed to describe the approach of flipped classroom performed to provide social distancing and to maintain teaching activities during COVID-19-pandemic. Methods Flipped Classroom was chosen to be associated with the role-play technique as a central methodology. To bring students closer to activities performed in the non-pandemic period, some actions and assessments were also role-played by Professor simulating patients in virtual meetings. Results Although the changes in the format of the lessons, our approaches stimulated the students maintained the high frequency of students in the activities (almost 100%) providing continuity activities. Conclusions This report can reinforce that meaningful learning can be taught by using a virtual/remote approach. However, the potential positive results observed cannot be used as an excuse to maintain remote teaching activities with the objective of cost-cutting by the institutions.

Are Stress Associated with Temporomandibular Dysfunction? A Cross-Sectional Study / O Estresse Está Associado à Disfunção Temporomandibular? Um Estudo Transversal

Temporomandibular disorders are frequent in different segments of the population and harm the quality of life of individuals. The present sudy aimed to investigate the association between stress and temporomandibular dysfunction (TMD) in university students in Brazil. All incoming students at the Federal University of Pelotas were invited to participate in this cross-sectional study. A self-administered questionnaire was used with socioeconomic and oral health variables. TMD Fonseca questionnaire "Fonseca's anamnestic index" was used to identify the severity of symptoms of temporomandibular dysfunction. The same was elaborated in the form of Helkimo's anamnestic index. Stress was measured using a modified version of the Perceived Stress Scale and categorized into quartiles. Logistic multivariable regression models were used to analyze the associations of interest controlling for possible confounding variables. A backward stepwise procedure was used to select variables that should be kept in the final model. A total of 2,089 students answered the questionnaires and 82 (3.9%) were classified with the presence of TMD. Adjusted logistic regression shows that chance of presenting temporomandibular dysfunction was higher (OR=2.43; 95%CI=1.04-5.65) when the stress level increased. In conclusion, the mild degree of temporomandibular dysfunction was the most prevalent. Stress was associated with individuals with a higher prevalence of temporomandibular dysfunction. (AU)

As disfunções temporomandibulares são frequentes em diferentes segmentos da população e prejudicam a qualidade de vida dos indivíduos. O presente estudo teve como objetivo investigar a associação entre estresse e disfunção temporomandibular (DTM) em estudantes universitários no Brasil. Todos os alunos ingressantes da Universidade Federal de Pelotas foram convidados a participar deste estudo transversal. Foi utilizado um questionário autoaplicável com variáveis ​​socioeconômicas e de saúde bucal. O questionário TMD Fonseca "Índice anamnésico de Fonseca" foi utilizado para identificar a gravidade dos sintomas da disfunção temporomandibular. O mesmo foi elaborado na forma de índice anamnésico de Helkimo. O estresse foi medido usando uma versão modificada da Perceived Stress Scale e categorizado em quartis. Modelos de regressão logística multivariada foram usados ​​para analisar as associações de interesse controlando possíveis variáveis ​​de confusão. Um procedimento de backward stepwise foi usado para selecionar as variáveis ​​que deveriam ser mantidas no modelo final. Um total de 2.089 alunos responderam aos questionários e 82 (3,9%) foram classificados com presença de DTM. A regressão logística ajustada mostra que a chance de apresentar disfunção temporomandibular foi maior (OR=2,43; IC95%=1,04-5,65) quando o nível de estresse aumentou. Em conclusão, o grau leve de disfunção temporomandibular foi o mais prevalente. O estresse foi associado a indivíduos com maior prevalência de disfunção temporomandibular. (AU)

Laser photobiomodulation effect on fibroblasts viability exposed to endodontic medications

Aim: The literature has not yet reported investigations about the effect of laser photobiomodulation (LPBM) over the cytotoxicity of drugs for endodontic treatments. Thus, the aim of this study was to evaluate, in vitro, the effect of the association between LPBM and intracanal medications on fibroblasts viability in different exposure times. Methods: Calcium hydroxide (Ca(OH)2) and iodoform (IO) were used pure or associated to LPBM. Eluates of medications were prepared and placed in contact with the cells in three different periods: 24h, 48h and 72h. Laser irradiation (emitting radiation λ 660nm, power density of 10mW, energy density of 3 J/cm²) has been performed in two sessions within a six hour interval, for 12s per well. After each experimental time, the colorimetric assay (MTT) has been performed. Statistical analysis was applied for Mann-Whitney test with 5% α error admitted test. Results: At 24h, the use of LPBM did not increase cell viability while after 72h cell proliferation was stimulated in the group without medications. LPBM application did not increase cell viability in Ca(OH)2 group and IO at any tested time. Ca(OH)2 cytotoxicity at 24h was higher than iodoform, while at 72h not difference was observed. Therefore, after 72 hours was no statistical difference between the IO and Ca(OH)2 groups. Conclusion: LPBM was able to increase cell viability in 72h in the group without medication, although no improvement was observed in the other groups. Thus, LPBM was not able to reduce the cytotoxic effects of the materials on fibroblasts in vitro

Dentist's preferences on vital and nonvital tooth bleaching: findings from a Guatemalan survey

Aim: The present study aimed to investigate if the Guatemalan dentist's options on tooth bleaching could be influenced by their time in clinical practice, the level of specialization or their working place. Methods: A representative sample of dentists working in clinical practice in Guatemala was selected. Data were collected using a self-administered questionnaire with information related to gender, professional characteristics (time since graduation in years and working place) and preferences regarding vital (at-home or in-office; type and concentration of bleaching agent) and the nonvital tooth bleaching (bleaching agent used). The analysis was performed and the association between preference for bleaching technique and independent variables were investigated using Fisher's exact test. Results: 200 dentists were interviewed. More than half of dentists were male (57.0%) with time since graduation between 11 and 20 years (n= 64; 32.3%). Dentists mostly (60.5%) preferred in-office technique for vital bleaching, with 10-20% Carbamide peroxide (CP) as the preferred agent (50%). For nonvital teeth, the preferred agent (46.8%) was 37% Hydrogen Peroxide (HP). About the associations, younger dentists (< 20 years of graduation) selected mostly in-office technique, while those with more than 20 years indicated more the at-home technique. Also, the dentists working in private practice chose more frequently in-office technique. Thus, the in-office technique was more popular among Guatemalan dentists, with 10-20% CP and 37% HP selected as favorite bleaching agents for vital and nonvital techniques, respectively. Conclusion: The time of clinical practice and working place influenced some choices

Are stress and symptoms of depression associated with halitosis? A cross-sectional study

Mood disorders such as stress and depression can promote alterations of several hormones Aim: The present study aimed to evaluate if symptoms of depression and stress are associated with halitosis. The hypothesis is that halitosis is associated with stress and depression symptoms. Methods: All university students' entrants in the Federal University of Pelotas (UFPel) were invited to participate. Self-reported halitosis was measured using a visual analog scale. Students were also asked about the presence of halitosis perceived by close individuals. The stress level was measured using a modified version of the Perceived Stress Scale and symptoms of depression were screened by Patient Health Questionnaire-2. Poisson Regression Models were performed. Results: Of a total of 2,058 students who participated in the study, only 16% of them have reported not having any degree of halitosis and 17.6% were informed of closed individuals having halitosis. After adjustments, stress and depression symptoms remained associated with halitosis selfreported. Individuals from the higher stressed quartile presented higher scores of halitosis (RR 1.37 CI95% [1.24­1.53]). Students who presented depressive symptoms showed higher scores of self-perceived halitosis (RR 1.20 CI95% [1.10­1.32]). When the association of stress and halitosis reported by close individuals was tested, symptoms of depression lost the association in the adjusted model, while individuals from the highest quartile from stress remained associated (PR 1.36 CI95% [1.02­1.81]). Conclusion: Halitosis was associated with stress even after control for oral health and socioeconomic variables

Use of Health Services and Family Health Strategy Households Population Coverage in Brazil / Utilização dos Serviços de Saúde e Estratégia Saúde da Família Cobertura da População Domiciliar no Brasil

Abstract The objective of this study is to describe the profile of use of primary health care services, estimated by the PNS, of the population living in households registered and not registered with the Famly Health Strategy - FHS, in the years 2013 and 2019. Cross-sectional study carried out using microdata from national health surveys 2013 and 2019. The sample originated from a master sample, consisting of a set of units from selected areas in a register..The variables sex, age, skin color, income, education, self-perceived health, home registered with the FHS, medical care in the last year, type of service you seek when you are ill were selected. The dependent variables were use of health services and use of public health services. The dependent and independent variables were described with the respective confidence interval and adjusted logistic regression was performed for each outcome analyzed. In public health services, lower income, have chronic diseases (arterial hypertension or high cholesterol), be pregnant, and having a bad self-perception of health were associated with used more health services in both periods. Living in registered households was associated with more used health services (public or private). The family health strategy is an important strategy for expanding access equally.

Resumo O objetivo deste estudo é descrever o perfil de utilização dos serviços de atenção primária à saúde, estimado pela Pesquisa Nacional de Saúde (PNS), da população residente em domicílios cadastrados e não cadastrados na Estratégia de Saúde da Família (ESF), nos anos de 2013 e 2019. Estudo transversal realizado com microdados dos inquéritos nacionais de saúde entre 2013 e 2019. A amostra originou-se de uma amostra mestra, composta por um conjunto de unidades de áreas selecionadas em um cadastro. Variáveis ​​sexo, idade, cor da pele, renda, escolaridade, autopercepção de saúde, domicílio cadastrado na ESF, atendimento médico no último ano, tipo de serviço que você procura quando está doente foram selecionados. As variáveis ​​dependentes foram uso de serviços de saúde e uso de serviços públicos de saúde. As variáveis ​​dependentes e independentes foram descritas com os respectivos intervalos de confiança e foi realizada regressão logística ajustada para cada desfecho analisado. Nos serviços públicos de saúde, menor renda, ter doenças crônicas (hipertensão arterial ou colesterol alto), estar grávida e ter uma autopercepção de saúde ruim estiveram associados à maior utilização de serviços de saúde nos dois períodos. Morar em domicílios cadastrados na ESF foi associado aos serviços de saúde mais utilizados (públicos ou privados). A estratégia de saúde da família é uma estratégia importante para expandir o acesso de forma igualitária.

Ensino em saúde LGBTQI+ para alunos de odontologia: uma revisão sistemática / LGBTQI + healtheducation for dental students: a systematic review

Objetivo: investigar, na literatura odontológica, estudos que abordem diferentes aspectos do ensino de temas LGBTQI+ (Lésbicas, Gays, Bissexuais, Transexuais, População Quer, Intersexo e outros) nos cursos de odontologia e quais são as abordagens pedagógicas sugeridas para reduzir preconceitos e discriminação no atendimento odontológico. Metodologia: uma busca foi conduzida nas bases de dados PubMed, Scopus, Web of Science e BVS/Bireme, até julho de 2017. Após a remoção de duplicatas, dois revisores independentes conduziram a seleção dos artigos. Resultados: a busca inicial resultou em 924 títulos. Após leitura completa, apenas oito completaram os critérios de inclusão. Os artigos incluídos nesta revisão demonstraram que alunos, lideranças estudantis e administradores reconhecem medidas de suporte, apoio e inclusão existentes. Algumas instituições apresentaram em seu currículo temas relacionados com a população LGBTQI+, porém, relacionadas frequentemente com doenças. Essa cobertura é apontada como fraca e insuficiente para o atendimento qualificado. Apenas dois estudos apresentaram métodos para o ensino de questões LGBTQI+; entretanto, apenas um avaliou qualitativamente seus resultados. Conclusão: existe uma grande carência de estudos que descrevam abordagens e métodos de ensino de temas LGBTQI+ na odontologia.(AU)

Objective: to investigate in the dental literature studies addressing different aspects of LGBTQI+ (Lesbians, Gays, Bisexuals, Transsexuals, Queer Population, Intersex and others) education topics and the approaches used to reduce inequalities and prejudices in dental care. Methods: a search was conducted in the PubMed, Scopus, Web of Science and BVS/Bireme databases, until July 2017. After removing duplicates, two independent reviewers conducted the selection of articles. Results: the initial search resulted in 924 titles. After complete reading, eight studies completed the inclusion criteria. The articles included in this review demonstrated that students, student leaders and administrators recognize support and inclusion measures. Some institutions presented topics related to the LGBTQI+ population in their curriculum, but often related to diseases. This approach was identified as weak and insufficient for a qualified service. Only two studies presented methods for teaching LGBTQI+, but only one assess qualitative results. Conclusions: there is a lack of studies that approach the education of LGBTQI+ topics mainly related to teaching methodologies.(AU)

Hydroxyapatite Synthesis and Covering of Titanium Surfaces by Dip-Coating Method

Abstract This study developed and characterized a method for controlled deposition of thin films of hydroxyapatite on titanium surfaces. Thirty-three titanium cylinders were randomly divided: negative control/polished (A), acid etched (B) and coated by hydroxyapatite (C). Acid etch was performed in an aqueous solution of nitric acid. The cylinders were subjected to coating by a thin film of hydroxyapatite with dip-coating method. These cylinders were submitted to a pre-heat treatment 450°C/10 minutes and 800°C/2 hours. Scanning electron microscopy analysis demonstrated a homogeneous and smooth surface (A), an irregular and porous surface (B) and a crystalline deposition (C). The X-ray energy dispersive analysis showed characteristic elements of hydroxyapatite (C). Analysis by X-ray diffraction showed the presence of characteristic peaks of hydroxyapatite, corresponding to the structural composition of hydroxyapatite. Cell viability (MTT-assay in NIH-3T3-Cells) test demonstrated no differences between the groups. Titanium surfaces coated with a hydroxyapatite film by the dip-coating method suggest adequate control of deposition of thin films of hydroxyapatite and similar cell viability using mouse fibroblasts.

Triple-blinded randomized clinical trial comparing efficacy and tooth sensitivity of in-office and at-home bleaching techniques

Abstract Objective Our study aims to compare the efficacy and tooth sensitivity following in-office (35% hydrogen peroxide) or at-home (10% carbamide peroxide) bleaching treatments both preceded by 2% potassium nitrate (2%KF) desensitizing gel. Methodology 130 volunteers were randomly allocated to a) in-office bleaching and a placebo at-home protocol; or b) in-office placebo and at-home bleaching treatment. 2% KF was applied for 10 min before both treatments. Objective color evaluation was performed (spectrophotometer CIEL*a*b* system and CIEDE2000) to calculate the color change (ΔE00). Subjective evaluation was performed using the VITA classical shade guide followed by shade variation (ΔSGU) at the beginning and end of bleaching treatment and 2 weeks post-bleaching. Tooth sensitivity was daily recorded using a Likert scale varying from 1 (no sensitivity) to 5 (severe sensitivity). Analysis was carried out using non-parametric tests. Results Regarding the color change, at-home bleaching resulted in significant color improvement compared to in-office treatment for the parameters Δb* (p=0.003) and Δa* (p=0.014). Two weeks post-bleaching, the at-home treatment resulted in significant color improvement compared to in-office treatment for the parameters Δb* (p=0.037) and ΔE00 (p=0.033). No differences were observed in either ΔSGU parameters. Concerning sensitivity, patients treated with in-office bleaching reported more tooth sensitivity than the at-home group only on the first day after bleaching started, without significant differences in the other periods evaluated (p>0.05). Conclusions At-home and in-office bleaching, preceded by a desensitizing agent, were effective for vital teeth bleaching and 10% carbamide peroxide produced a higher whitening effect than 35% hydrogen peroxide in the short time evaluation. Tooth sensitivity rates were similar for the two techniques tested.

COVID-19 Pandemic impact on Brazil's Public Dental System

Abstract: The present study aimed to estimate the impact of the COVID-19 pandemic on dental care procedures in the Public Health System in Brazil. A retrospective, ecological study was carried out, comprising 5,564 Brazilian municipalities. The number of dental procedures (per 100,000 inhabitants) performed in the Brazilian Public Health System (SUS) was the outcome. The impact of the pandemic was estimated by comparing the rate of procedures for each month of 2020 with the rates observed in the equivalent months in 2019, considering the period from March to August. Regulatory legislation regarding restrictions on dental care, issued by the state governments of 27 Brazilian federative units, was used for mediation analysis. A 55% reduction was observed in March for all procedures (IRR = 0.45, 95%CI 0.39-0.51), while in the other months, the rate of reduction remained ≥ 88%. The biggest decrease was observed in collective preventive procedures (reduction ≥99%) between April and August. Procedures that were less likely to generate aerosols (tooth extraction and prosthetic) and emergencies showed the smallest reduction. The reduction was not mediated by the restrictions imposed by state governments (p>0.05). The impact of the COVID-19 pandemic was noteworthy in terms of the decrease in the number of dental procedures carried out in the Brazilian Public Dental Service. The lack of access, the delay of elective procedures and the lack of preventive collective procedures could result in an overburdened system, post-Pandemic.

Impact of the COVID-19 pandemic on prenatal, diabetes and medical appointments in the Brazilian National Health System / Impacto da pandemia COVID-19 no Pré-natal, Diabetes e consulta médica no Sistema Único de Saúde Brasileiro

ABSTRACT: Objectives: The purpose of this study was to describe the impact of the COVID-19 pandemic on Primary Health Care in Brazil. Methodology: This retrospective ecological study was carried out using Brazilian municipality data obtained from the information systems of the National Public Health System. The outcomes were medical appointments, prenatal procedures and diabetes care. The exposure variable was the occurrence of the COVID-19 pandemic, based on the first case reported in Brazil. Multilevel mixed-effects negative binomial regression was used to analyze the association between the number of procedures per 10,000 inhabitants and COVID-19. Results: Data from 5,564 Brazilian municipalities were included in the present study. Regarding medical appointments, the largest reduction occasioned by the pandemic occurred in May (IRR = 0.27, 95%CI 0.24 - 0.30). Prenatal procedures were reduced by 65% (IRR = 0.35, 95%CI 0.32 - 0.38), also in May. In addition, diabetes care saw the biggest reductions in April 2020 (IRR = 0.24, 95%CI 0.11 - 0.53) and May 2020 (IRR = 0.19, 95%CI 0.09 - 0.43). From February to December 2020, the pandemic had a significant effect on the total number of procedures evaluated. Conclusion: The findings showed a reduction in prenatal procedures, diabetes and medical consultations performed in Brazil's Primary Health Care, following the onset of the COVID-19 pandemic.

RESUMO: Objetivos: O objetivo do presente estudo foi descrever o impacto da pandemia de covid-19 na Atenção Primária à Saúde (APS) Brasileira. Métodos: Estudo ecológico retrospectivo realizado com dados de municípios brasileiros, obtidos nos sistemas de informação do Sistema Único de Saúde (SUS). Os desfechos do estudo foram as consultas médicas, procedimentos de pré-natal e tratamento de diabetes. A exposição foi a ocorrência da pandemia de covid-19, a partir do primeiro caso notificado no Brasil. Regressões binomiais negativas de efeitos mistos multinível foram utilizadas para analisar a associação entre o número de procedimentos por 10.000 habitantes e a pandemia de covid-19. Resultados: Dados de 5.564 municípios brasileiros foram incluídos no presente estudo. Em relação à consulta médica, a maior redução devido à pandemia em curso ocorreu em maio (IRR = 0,27, IC95% 0,24 - 0,30). Para os procedimentos de pré-natal, a redução foi de 65% (IRR = 0,35, IC95% 0.32 - 0.38), também em maio. Ainda assim, os procedimentos de tratamento do diabetes tiveram maiores reduções em abril (IRR = 0,24, IC95% 0,11 - 0,53) e maio (IRR = 0,19, IC95% 0,09 - 0,43) de 2020. De fevereiro a dezembro de 2020, a pandemia de covid-19 impactou significantemente o total de procedimentos avaliados. Conclusão: Os achados mostraram uma redução de procedimentos de pré-natal, diabetes e consultas médicas realizadas na Atenção Primária à Saúde (APS) do Brasil, após o início da pandemia de covid-19.

Racial and regional inequalities of dental pain in adolescents: Brazilian National Survey of School Health (PeNSE), 2009 to 2015 / Desigualdades raciais e regionais na prevalência de dor de dente em adolescentes: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009 a 2015 / Desigualdades raciales y regionales respecto al dolor dental en adolescentes: Encuesta Nacional de Salud del Escolar (PeNSE), de 2009 a 2015

Abstract: The aim of the study is: (a) investigate the racial inequalities as one specific dimension that affects dental pain in Brazilian adolescents; and (b) investigate the regional variations of dental pain. This cross-sectional study used data from Brazilian National Survey of School Health (PeNSE), carried out with adolescents in 2009, 2012 and 2015. Dental pain was evaluated through the question: "Did you have dental pain in the last six months?". The main exposures were race and Brazilian regions, used to evaluate inequalities related to the outcome. Sex, age, school type and maternal education were used as covariables. The statistical significance of the trends in dental pain was tested using linear regression. The analysis was conducted in Stata 13.0 statistical package using the svy command. The standard prevalence of dental pain was 18.8%, 21.1% and 23.7%, showing an increasing trend over time (p < 0.001). We observed absolute inequalities in dental pain related to race and regions. A higher prevalence was found in non-white girls of public schools and in the Northern Region. The indexes of inequalities increased in the group of black girls, related to an increase of dental pain predominantly in girls whose mothers had lower educational level. It was observed that the prevalence of dental pain in Brazilian adolescents increased over time as well as its inequalities, which remained in marginalized populations and linked to Brazilian regions.

Resumo: O estudo teve dois objetivos: (a) investigar as desigualdades raciais enquanto uma dimensão específica que afeta a prevalência de dor de dente em adolescentes brasileiros, e (b) analisar as variações regionais na prevalência de dor de dente. O estudo transversal usou dados da Pesquisa Nacional de Saúde do Escolar (PeNSE), realizada com adolescentes em 2009, 2012 e 2015. Dor de dente foi avaliada com a pergunta: "Nos últimos seis meses, você teve dor de dente?". As principais exposições foram raça/cor e macrorregiões brasileiras, usadas para avaliar as desigualdades relacionadas ao desfecho. Sexo, idade, tipo de escola e escolaridade materna foram as covariáveis utilizadas. A significância estatística das tendências na prevalência de dor de dente foi testada com regressão linear. As análises foram realizadas com o programa estatístico Stata 13.0, usando o comando svy. A prevalência padrão de dor de dente foi 18,8%, 21,1% e 23,7%, com uma tendência crescente ao longo do tempo (p < 0,001). Foram observadas desigualdades absolutas na prevalência de dor de dente de acordo com raça e macrorregião. A prevalência mais alta esteve associada ao sexo feminino, raça não-branca, escola pública e Região Norte do país. Os índices de desigualdade aumentaram no grupo de meninas negras, refletidos em um aumento na prevalência de dor de dente em meninas cujas mães tinham menos escolaridade. A prevalência de dor de dente em adolescentes brasileiros aumentou ao longo do tempo, e as desigualdades em relação à dor de dente persistiram nas populações marginalizadas e de acordo com a região do país.

Resumen: El objetivo del estudio fue doble: (a) investigar las desigualdades raciales, como una dimensión específica que afecta al dolor dental, en adolescentes brasileños; e (b) investigar las variaciones regionales del dolor dental. Este estudio transversal usó datos de la Encuesta Nacional de Salud del Escolar (PeNSE), llevada a cabo con adolescentes en 2009, 2012 y 2015. El dolor dental fue evaluado por la pregunta: "En los últimos seis meses, ¿sufriste dolor dental?". Los principales factores de exposición fueron raza y regiones brasileñas, y se usaron para evaluar las desigualdades relacionadas con los resultados. Sexo, edad, tipo de escuela y educación maternal fueron las covariables usadas. La significación estadística de las tendencias en el dolor dental fue probada usando regresión lineal. El análisis se realizó con el paquete estadístico Stata 13.0, usando el comando svy. El estándar de prevalencia de dolor dental fue 18,8%, 21,1% y 23,7%, con tendencia a aumentar a lo largo del tiempo (p < 0.001). Se observaron desigualdades absolutas en el dolor dental, relacionadas con raza y regiones. Se encontró una prevalencia más alta en chicas, de raza no blanca, escuelas públicas y Región del Norte. Los índices de desigualdades se incrementaron en el grupo de chicas negras, en detrimento de un incremento en la prevalencia del dolor dental en chicas cuyas madres contaban con menos educación formal. Se observó que la prevalencia de dolor dental en adolescentes brasileñas se incrementó a lo largo del tiempo y las desigualdades, respecto al dolor dental, continuaron manteniéndose en el tiempo en poblaciones marginalizadas y acordes con determinadas regiones brasileñas.

Normative and subjective need for dental prosthesis: accuracy and agreement in a population based-study / Necessidade normativa e subjetiva de próteses dentárias: acurácia e concordância em um estudo populacional / Necesidad normativa y subjetiva de prótesis dentales: precisión y concordancia en un estudio poblacional

Abstract: The aim of our study was to compare normative need for dental prosthesis (estimated by dentists) with subjective need (self-reported) by testing the accuracy and agreement and comparing direction and magnitude of associations with independent variables using both as outcomes. A representative sample of a birth cohort study (n = 900) was assessed at 31 years of age. Subjective need was obtained from questionnaire. Both normative and subjective need variables were dichotomized in (a) individuals with need for dental prosthesis and (b) without need for dental prosthesis. Accuracy was assessed by sensitivity (SE), specificity (SP), positive (PPV) and negative (NPV) predictive values. Agreement of normative and subjective need was assessed estimating kappa index. Sex, income, educational level, use of dental services and self-reported oral health were used to compare the associations with normative and subjective need. Prevalence of normative need was 48.9% and subjective need was 34.9%. Agreement (kappa: 0.43) and accuracy between normative and subjective need for dental prosthesis was low (SE: 56.5, 95%CI: 50.3-62.6; SP: 85.8, 95%CI: 81.1-89.7; PPV: 79.1, 95%CI: 72.6-84.7; NPV: 67.3, 95%CI: 62.1-72.2). When considering individuals with loss in anterior teeth, results showed a good agreement (kappa: 0.82) and accuracy between normative and subjective need (SE: 93.3, 95%CI: 68.1-99.8; SP: 88.9, 95%CI: 51.8-99.7; PPV: 93.3, 95%CI: 68.1-99.8; NPV: 88.9, 95%CI: 51.8-99.7). Direction and magnitude of associations with normative and subjective need were similar. Thus, normative need for dental prosthesis differs from subjective need in adults, except when anterior losses are present.

Resumo: O estudo teve como objetivo comparar a necessidade normativa de prótese dentária (estimada por dentista) com a necessidade subjetiva (autorrelatada), testando a acurácia e concordância e comparando a direção e magnitude das associações com variáveis independentes, usando necessidade normativa e subjetiva como os desfechos. Foi avaliada uma amostra representativa de uma coorte de nascimentos (n = 900), aos 31 anos de idade. A necessidade subjetiva foi obtida com um questionário. As variáveis necessidade normativa e subjetiva foram analisadas dicotomicamente como: (a) com necessidade de prótese dentária e (b) sem necessidade de prótese dentária. A acurácia foi avaliada enquanto sensibilidade (SE), especificidade (SP), valor preditivo positivo (VPP) e valor preditivo negativo (VPN). A concordância entre necessidade normativa e subjetiva foi avaliada com a estimativa do índice kappa. Sexo, renda, escolaridade, uso de serviços de odontologia e percepção da própria saúde oral foram usados para comparar as associações entre necessidade normativa e subjetiva. A prevalência de necessidade normativa era 48,9% e de necessidade subjetiva, 34,9%. A concordância (kappa: 0,43) e acurácia entre as necessidades normativa e subjetiva de prótese dentária eram baixas (SE: 56,5, IC95%: 50,3-62,6; SP: 85,8, IC95%: 81,1-89,7; VPP: 79,1, IC95%: 72,6-84,7; VPN: 67,3, IC95%: 62,1-72,2). Nos indivíduos com perda de dentes anteriores, os resultados mostraram boa concordância (kappa: 0,82) e acurácia entre necessidade normativa e subjetiva (SE: 93,3, IC95%: 68,1-99,8; SP: 88,9, IC95%: 51,8-99,7; VPP: 93,3, IC95%: 68,1-99,8; VPN: 88,9, IC95%: 51,8-99,7). A direção e magnitude das associações com necessidade normativa e subjetiva eram semelhantes. Portanto, a necessidade normativa de prótese dentária difere da necessidade subjetiva em adultos, exceto quando há perda de dentes anteriores.

Resumen: El objetivo de este estudio fue comparar la necesidad normativa de prótesis detal -estimada por los dentistas- con la necesidad subjetiva -autoinformada-, probando la precisión y concordancia, así como comparando la dirección y magnitud de asociaciones con variables independientes, usando ambas como resultados. Se evaluó una muestra representativa de un estudio de cohorte de nacimientos (n = 900) a los 31 años de edad. La necesidad subjetiva procede de un cuestionario. Ambas variables necesidad normativa y subjetiva fueron dicotomizadas en (a) individuos con necesidad de una prótesis dental y (b) sin necesidad de una prótesis dental. La precisión se evaluó por sensibilidad (SE), especificidad (SP), valores predictivos positivos (PPV) y negativos (NPV). La concordancia entre necesidad normativa y subjetiva se evaluó estimando el índice de kappa. Sexo, ingresos, nivel educacional, uso de servicios dentales y autoinformados de salud oral se usaron para comparar las asociaciones con necesidad normativa y subjetiva. La prevalencia de necesidad normativa fue 48,9% y la de necesidad subjetiva fue 34,9%. Concordancia (kappa: 0,43) y precisión entre la necesidad normativa y subjetiva de prótesis dental fue baja (SE: 56,5, IC95%: 50,3-62,6; SP: 85,8, IC95%: 81,1-89,7; PPV: 79,1, IC95%: 72,6-84,7; NPV: 67,3, IC95%: 62,1- 72,2). Cuando consideramos a individuos con pérdidas de dientes anteriores, los resultados mostraron una buena concordancia (kappa: 0,82) y precisión entre necesidad normativa y subjetiva (SE: 93,3, IC95%: 68,1-99,8; SP: 88,9, IC95%: 51,8-99,7; PPV: 93,3, IC95%: 68,1-99,8); NPV: 88,9, IC95%: 51,8-99,7). La dirección y magnitud de las asociaciones con necesidad normativa y subjetiva fueron similares. Por lo tanto, la necesidad normativa de prótesis dentales difiere de la necesidad subjetiva en adultos, excepto cuando están presentes las pérdidas de dientes anteriores.

Is obesity associated with tooth loss due to caries? A Cross-sectional study

Aim: To investigate the association between obesity, overweight, and tooth loss due to caries among university students of (Federal University of Pelotas) in southern Brazil. Methods: A cross-sectional study with all first-year students who regularly enrolled in the first semester of 2016 who were invited to respond to a self-administered questionnaire contain socioeconomic and demographic; psychosocial; oral health; behavioral questions. The body mass index (BMI) was calculated through the self-reported data of weight and height. The main outcome of the present study was determined by the person's that answer having had at least one tooth extracted due to caries. A Poisson regression using a backward stepwise procedure was performed. Two models were tested: i) including socioeconomic and behavioral variables; ii) without behavioral variables. Results: From 3,237 eligible students, 2,089 (64.5%) participated in the present study. Almost 23% of students presented overweight and 8.4% obesity, whereas 362 individuals (17.5%) reported having had at least one tooth extracted due to caries. Regarding the final model adjusted by behavioral variables, it was observed that obese university students presented a 32.0% higher prevalence of tooth loss (PR=0.32,CI95%[1.17­1.49]). However, overweight was not associated with tooth loss in the present sample. When the model was not associated with behavioral variables, overweight was associated with tooth loss (PR=1.44; CI95%[1.15­1.81]), just as obesity (PR=2.13; CI95%[1.63 ­ 2.78]). Conclusions: Obesity and overweight were associated with tooth loss due to caries in the present sample of university students