Association between frailty and oral health services use in Brazilian older adults.

OBJECTIVES: To assess the association between frailty and oral health services use in Brazilian older adults. METHODS: This cross-sectional study analysed the baseline data from the Longitudinal Study on Brazilian Ageing (ELSI-Brazil) representative of Brazilians aged 50 or over. The outcome was oral health services used in the year prior to the interview. The main exposure variable was Frailty defined by the frailty phenotype. Age, skin colour, wealth, sex, education, type of service, health insurance, number of teeth and self-perceived oral health were included as covariates. Prevalence ratios (PR) with their respective 95% confidence intervals (CI) were estimated using Poisson regression with robust variance. RESULTS: 8405 individuals were included in this study. The prevalence of frailty was 7.5%. Regarding frailty status, the prevalence of dental service use was 47.0%, 48.5% and 4.5% for robust, pre-frail and frail individuals, respectively. Frail individuals had a 7% higher prevalence of not using dental (PR: 1.07; 95% CI: 1.01-1.13) than robust individuals. Frailty was independently associated with not using oral health services. CONCLUSION: Given the complexity of the determinants of dental service use, frailty adds another dimension to be examined in older adults. Public health strategies considering a common risk factor approach should be endorsed.

Preventive dental service use and oral health-related quality of life in Brazilian older adults.

BACKGROUND: Information on the use of preventive dental services and associated variables is needed to guide policy for the old adult population and consequently promote better oral health-related quality of life (OHRQoL). OBJECTIVE: To investigate the association between preventive dental service use and OHRQoL by older Brazilians. MATERIALS AND METHODS: This cross-sectional study was carried out using the baseline data of participants of the Brazilian Longitudinal Stud of Aging (ELSEI-Brazil) who were aged 60 years or more. Associations with the use of preventive dental services were carried out using Poisson regression models with robust variance, adjusting for confounders. RESULTS: The final sample consisted of 5432 older adults. Almost all (90.7%) participants reported not having sought preventive dental services in the last year. Individuals who used dental services for prevention had fewer impacts on their OHRQoL (RR: 0.74; [95% CI: 0.57-0.97]). CONCLUSION: Preventive dental service use is associated with a better OHRQoL in older Brazilians. Policies to improve access to preventive dental services may result in improved OHRQoL in this age group.

Predictors of tooth loss in Brazilian older adults: An 8-year follow-up.

OBJECTIVE: To investigate the risk factors for tooth loss after 8 years among community-dwelling older adults in a southern Brazilian city. METHODS: In 2004, 388 dentate community-dwelling older adults from Carlos Barbosa, southern Brazil, were selected using simple random sampling. In 2012, the follow-up consisted of 199 (51.3%) participants. Data collection comprised an interview with data about socio-demographic, behavioural and access to services and an oral examination. The outcome variable of this study is the ratio between the sum of the teeth lost during the 8-year period of follow-up, and the sum of the teeth present in 2004, per person, modelled through binomial regression analysis. RESULTS: Being older (IOR = 1.03, 95% CI: 1.00-1.06), living in a rural area (IOR = 1.56, 95% CI: 1.17-2.07), earning two or more monthly minimum wages (IOR = 1.46, 95% CI: 1.09-1.96), living alone (single, widowed or divorced; IOR = 1.36, 95% CI: 1.00-1.85), having more gingival bleeding sites (IOR = 1.01, 95% CI: 1.00-1.02) and wearing partial removable prosthesis (IOR = 2.82, 95% CI: 2.15-3.71) were risk factors for tooth loss. Approximately 48% of the participants lost one or more teeth over the 8-year follow-up period. CONCLUSION: Socio-demographic, economic and clinical variables were associated with the risk for tooth loss. This might be a result of social determinants of health influencing people's access to oral health care, oral health behaviours and oral health status. Public policy aimed at older adults living in rural areas, living alone and using removable dentures may contribute to reducing the risk of tooth loss.

Residual dentition, prosthesis type and oral health-related quality of life in Uruguayan adults.

OBJECTIVES: To investigate the association between different types of dental prostheses (and residual dentition) and oral health-related quality of life (OHRQoL). METHODS: A population-based study with a representative sample of adults and older adults in Uruguay (2010-2011). The dependent variable was the score on the oral impact on daily performance (OIDP), and the main predictor was the pattern of tooth loss and prosthesis use. Covariates included sex, age, socioeconomic status, education, missing teeth, pain and decayed teeth. Negative binomial regression was used. RESULTS: The sample comprised 762 participants. Those participants not wearing a prosthesis and with extensive tooth loss had a mean OIDP of 3.1 (95% CI = 1.6-6.2), while those wearing removable partial dentures (RPD) and having <12 missing teeth had a mean OIDP of 3.6 (95% CI = 1.3-10.0). Participants with a free-end saddle had the highest mean OIDP, at 4.9 (95% CI = 2.0-12.1). For participants with ≤12 missing teeth, any additional missing tooth was associated with an 11% higher OIDP score. Participants who wore RDPs reported fewer impacts on OHRQoL if they had extensive tooth loss or anterior tooth loss than those with a free-end saddle, or who had lost fewer teeth. CONCLUSIONS: The use of RPDs is associated with better OHRQoL. These findings may be valuable in clinical practice and prosthetic planning.

Oral health status and quality of life of the parental caregivers of children with Down syndrome: A case-control study.

The aim of this study was to investigate the oral health status and quality of life (QOL) of the parental caregivers of individuals with Down syndrome (DS), and to evaluate whether there is an association between these variables. The sample of this cross-sectional study was composed by parental caregivers of children with DS (CCDS) and parental caregivers of children without DS (CNDSC). Oral examination was undertaken and a questionnaire was given to participants. QOL was evaluated by WHOQOL-Bref. CCDS presented a higher number of dental prosthesis users and higher gingival bleeding index compared to CNDSC. When oral health was associated with QOL, the use of dental prosthesis was associated with physical domain and the variables having chronic disease and family income were associated with the social domain for both caregivers. The results suggest that caregivers of children with DS have similar oral health and QOL compared to caregivers of children without DS. In both caregivers, oral health status is associated with QOL.

Frequency and associated factors for swallowing impairment in community-dwelling older persons: a systematic review and meta-analysis.

INTRODUCTION: Swallowing impairment (SI) is an underdiagnosed dysfunction frequently seen as an expected condition of aging. However, SI can lead to health complications and considerable social impact. METHODS: The objective of this systematic review with meta-analysis was to evaluate the frequency and associated factors with SI in community-dwelling older persons. Searches were performed in 13 electronic databases including MEDLINE and EMBASE (from inception to September 18, 2021). Data extraction and methodological quality assessment of included studies were performed by two independent reviewers. Meta-analysis of proportions with 95% confidence interval (CI) and prediction interval (PI) was used to pool estimates. Subgroup analysis by Country and Assessment Method was performed. General meta-analysis was used to pool measures of association between potential risk factors and SI occurrence (odds ratio [OR] or prevalence ratio [PR]). RESULTS: The worldwide estimated frequency of SI in community-dwelling older persons was 20.35% (95%CI 16.61-24.68%, 95%PI 4.79-56.45, I2 99%, n = 33,291). This estimation varied across assessment methods and by country. The main factors associated with SI were a dry mouth (OR 8.1, 95%CI 4.9-13.4), oral diadochokinesis (OR 5.3, 95%CI 1.0-27.3), ≥ 80 years old (OR 4.9, 95%CI 2.6-9.2), genetic factor (SNPrs17601696) (OR 4.8, 95%CI 2.7-8.3), and partial dependence (OR 4.3, 95%CI 2.0-9.3). And the main factors associated with SI estimated by PR were dry mouth sensation (PR 4.1, 95%CI 2.6-6.5), oral sensorimotor alteration (PR 2.6, 95%CI 1.4-4.9), osteoporosis (PR 2.51, 95%CI 1.2-5.3), and heart diseases (PR 2.31, 95%CI 1.1-5.0). CONCLUSION: One in five older adults worldwide are expected to experience SI and factors associated with this underdiagnosed dysfunction included biological and physiological changes related to aging, physical and psychological conditions, and poor oral health. Early assessment is paramount for the prevention of future clinical complications and should be a high priority in health care practices.

Effect of oral exercises and photobiomodulation therapy in the rehabilitation of patients with mandible fractures: randomized double-blind clinical trial.

Mandible fractures compromise stomatognathic functions, requiring rehabilitation. Evaluate the effectiveness of photobiomodulation (PBM) associated with oral exercises for rehabilitation of patients with mandible fractures. In this randomized clinical trial, we compared PBM with PBM sham in 14 adults with mandibular fractures who underwent surgical intervention. The sessions were performed 24 h and 48 h after surgical procedure, and weekly for 4 weeks after hospital discharge. Both groups performed oral exercises after each PBM session. Restriction of food consistencies, mandibular mobility, pain, and facial sensitivity measured before and after the surgical procedure were the outcomes evaluated, one and 3 months after surgery. Maximum interincisal distances (MID), exercise pain, and restriction of food consistencies were also evaluated during each week of intervention. Both groups showed normal MID (> 35 mm) and food consistencies consumed 1 month after the surgical procedure, with no significant differences between them. Individuals in the PBM group had less pain response to exercise during all the weeks of intervention than the sham group (p < 0.05). The patients presented a reduction in the painful response in MID and mandibular laterality movements 1 month after surgery compared to the preoperative period. In contrast, there was an improvement in laterality in the sham group only 3 months postoperatively and persistent pain in MID. There was no significant difference in facial sensitivity within and between groups during follow-up. The performance of oral exercises associated with PBM effectively facilitated the early rehabilitation of oral functions, with significant gains in pain management.

Maternal characteristics, home environment, and other factors associated with traumatic dental injuries in preschool children.

BACKGROUND/AIMS: The importance of external factors such as maternal and home characteristics on traumatic dental injuries needs to be investigated. The aim of this study was to evaluate the association between maternal and home characteristics and dental trauma in preschool children. MATERIAL AND METHODS: This cross-sectional study using a cluster random sample evaluated children between 3 and 4 years of age from Porto Alegre, Brazil. Mothers completed the Brazilian version of the Beck Depression and Anxiety Inventories (BDI and BAI). They answered questions about sociodemographics, maternal behaviors, and home characteristics. Dental trauma was assessed by the Children's Dental Health Survey criteria. Malocclusion and deleterious habits were also assessed. The multinomial logistic regression model was used to investigate the association of exploratory variables with different categories of dental trauma. Odds ratios (OR) and 95% confidence intervals were calculated. RESULTS: A total of 163 pairs of children and mothers agreed to participate (78.4% response rate). The prevalence of dental trauma was 49.8%. Mother's work outside the home, overjet, and anterior crossbite were associated with the occurrence of enamel trauma, while having a younger mother, families having more siblings, and having a mother with university education were associated with increased odds of dentin/pulp trauma. CONCLUSION: Depression and anxiety in the mothers were not associated with dental trauma, while malocclusion characteristics were more relevant for less severe, enamel trauma. Socioeconomic and home environment characteristics played a role in more severe, dentin/pulp trauma.

Asthma and oral changes in children: Associated factors in a community of southern Brazil.

BACKGROUND: Asthma is a chronic disease that involves several healthcare services that need attention in relation to its treatment and prevention. AIM: The objective of this study was to evaluate caries, erosion, and enamel defects in children with and without asthma. DESIGN: Cross-sectional study, with a sample of 228 children ages 6-12 years, stratified as asthmatic (n = 112) and non-asthmatic (n = 116), at two Primary Health Units of the Community Health Service, Brazil. The evaluation consisted of an oral examination and a structured interview with parents/guardians, in addition to data from medical records. Data were analysed by Poisson regression with a robust error variance, all of them at a level of significance of P < 0.05. RESULTS: Of 112 asthmatic children, 63 (51.2%) had dental caries and 25 (53.2%) enamel defects. In the adjusted analysis, dental caries and use of salbutamol were associated (PR = 1.32, 95% CI = 1.01-1.72). In addition, children who performed oral hygiene more than three times a day showed a greater prevalence (PR = 2.36, 95% CI = 1.02-4.85) of dental erosion compared with children who performed it only once a day. CONCLUSIONS: There is no evidence for an association between asthma, caries, erosion, and enamel defect in children aged from 6 to 12 years. There was, however, an association between dental caries and use of salbutamol.

Factors associated with hyposalivation and xerostomia in older persons in South Brazil.

OBJECTIVE: This study aimed to investigate characteristics associated with xerostomia and hyposalivation in older persons. BACKGROUND: Saliva is one of the most important body fluids and plays an important role in food bolus formation, lubricating the oral mucosa and protecting teeth against demineralisation. MATERIALS AND METHODS: This is a cross-sectional study nested within a cohort and includes a sample of 872 older persons living independently in the community, both in rural and urban areas in Carlos Barbosa, Brazil. Data collection included standardised interviews to identify sociodemographic, behavioural and health-related variables, as well as oral clinical examination performed by two trained/calibrated dentists. Poisson regressions with robust variance were used to calculate the crude and adjusted prevalence ratios (PR) and their respective 95% confidence intervals. RESULTS: The mean age was 68.5 ± 6.7 years, and the majority of the sample consisted of women (65.3%). The prevalence of xerostomia, of low stimulated salivary flow rate and low at rest salivary flow rate were 338 (38.8%), 494 (56.6%), 320 (36.7%), respectively. In the final adjusted model, women had a significantly increased prevalence of xerostomia (PR = 1.34; 95% CI: 1.12-1.61), as well as participants taking medication continuously (PR = 1.45; 95% CI: 1.16-1.82) and those with depressive symptoms (PR = 1.49; 95% CI: 1.27-1.76). Lower at rest (PR = 1.45, 95% CI: 1.22-1.72) and lower stimulated salivary flow were more prevalent in women (PR = 1.27, 95% CI: 1.11-1.44), while lower stimulated salivary flow was more prevalent in older persons taking medication continuously (PR = 1.24, 95% CI: 1.07-1.43). CONCLUSION: Salivary hypofunction and xerostomia were more prevalent in women and in those with continuous medication use; however, depressive symptoms were associated only with xerostomia. Measures are required to promote oral comfort in cases of xerostomia, thereby reducing the unpleasant sensation of dry mouth and hyposalivation consequences in clinical practice.

Motivational Interviewing in Preventing Early Childhood Caries in Primary Healthcare: A Community-based Randomized Cluster Trial.

OBJECTIVE: To assess the effectiveness of motivational interviewing in preventing early childhood caries compared with conventional oral health education. STUDY DESIGN: Twelve health care units in southern Brazil were randomly allocated in 2 groups of 6 and professionals in 1 group were trained in motivational interviewing. The mothers/children and external examiners were blinded to the intervention. The data were collected by calibrated examiners using questionnaires and a clinical examination based on modified International Caries Detection and Assessment System criteria. Of the 674 children born in the catchment area in the year 2013, 469 received the intervention (224 in the conventional oral health education group, 245 in the motivational interviewing group), and 320 were examined by the end of the study (145 in the conventional oral health education group, 175 in the motivational interviewing group), with mean age of 30 months. The final follow-up was 68%, after 3 years. RESULTS: Mean of decayed, missing, and filled surfaces at the end of the study period for the whole sample was 1.34 (95% CI 0.97-1.71). The caries rate per 100 surface-year in the conventional oral health education group was 1.74 (95% CI 1.14-2.34) and in the motivational interviewing group, it was 0.92 (95% CI 0.63-1.20). To correct for clustering effect and unbalanced factors, multilevel Poisson regression was fitted and the effect of motivational interviewing on the incidence rate ratio was 0.40 (95% CI 0.21-0.79). CONCLUSIONS: An intervention based on the principles of motivational interviewing style was more effective in reducing the number of surfaces affected by early childhood caries compared with conventional oral health education intervention. TRIAL REGISTRATION: ClinicalTrials.govNCT02578966, Brazilian Registry of Clinical Trials RBR-8fvwxq.

Influence of dental factors on oropharyngeal dysphagia among recipients of long-term care.

OBJECTIVE: The study evaluated the association of the sociodemographic, behavioural variables and the oral conditions with the presence of oropharyngeal dysphagia in long-term care older persons. BACKGROUND: Due to the influence of ageing, swallowing may be altered both in people with natural teeth and in those who have dentures or tooth loss. MATERIALS AND METHODS: This cross-sectional study evaluated 115 individuals older than 60 years, living in long-term care institutions of the State of Rio Grande do Sul in 2016. The diagnosis of dysphagia happen using a clinical speech evaluation, based on the research of signals and symptoms of alterations during deglutition, and on an oral sensory-motor evaluation. The dental clinical evaluation examined the oral cavity, teeth and dental prostheses, including a Xerostomia assessment. Poisson Regressions with robust variance was calculated were used to estimate crude and adjusted Prevalence Ratios(PR) and their IC95%. RESULTS: The sample was mostly comprised of older women (67.0%), with more than 81 years of age (44.3%) and edentulous (54.3%). Diagnosis of oropharyngeal dysphagia was verified in 60.9% of the participants. In the final model, older persons who presented no pair (PR=1.52(CI95%=1.02-2.40)) had a highest prevalence of oropharyngeal dysphagia, when compared to older persons who presented 8 to 14 mixed pairs, as well as those older persons who had more complaints related to symptoms of Xerostomia (PR=2.86(CI95% 1.58-5.18)). CONCLUSION: Institutionalised older persons with a poor oral health condition are associated with a higher prevalence of oropharyngeal dysphagia, as well as with the presence of Xerostomia.

Predictors of Satisfaction with Dentures in a Cohort of Individuals Wearing Old Dentures: Functional Quality or Patient-Reported Measures?

PURPOSE: To examine the extent to which denture satisfaction can be determined by a measure of the denture's functional quality and by patient-reported measures. MATERIALS AND METHODS: This study used data obtained from 117 edentulous individuals with a mean age of 73.7 (SD = 5.6) years in southern Brazil. The edentulous individuals rated their levels of general satisfaction with their actual dentures, using a visual analog scale. Explanatory variables included the individual's information about ability to chew, ability to speak, esthetics, and sociodemographic factors. The dentures were evaluated using the validated 9-item Functional Assessment of Dentures instrument. Bivariate statistical analyses and Poisson regression models (prevalence ratio [PR]; 95% CI; p < 0.05) were used to test the association of explanatory variables with patients' general satisfaction with their complete dentures. RESULTS: There was a statistically significant association between patients' general satisfaction and stability of maxillary (rocking movement) (adjusted PR = 1.28; 95% CI: 1.07-1.52) and mandibular dentures (occlusal displacement) (adjusted PR = 1.68; 95% CI: 1.16-2.43), masticatory ability (adjusted PR = 1.54; 95% CI: 1.08-2.19), and the age of the mandibular denture (adjusted PR = 1.47; 95% CI: 1.10-1.97). CONCLUSIONS: The results of this study indicated that measures of denture stability, masticatory ability, and age of dentures appeared to be determinants of patients' satisfaction with dentures.

Assessing changes in oral health-related quality of life and its factors in community-dwelling older Brazilians.

OBJECTIVE: To describe changes in oral health-related quality of life and to evaluate the associations of these changes in community-dwelling older people. MATERIALS AND METHODS: In this longitudinal study a representative sample of 872 older people, living in Brazil, was evaluated during 2004. The follow-up was carried out during 2008, with 587 older persons evaluated. A questionnaire assessing socio-demographic information, health history, oral health-impact profile and number of natural teeth was used. Changes in oral health-related quality of life were categorized as improvement or deterioration. Data analysis was performed using a hierarchical approach based in a conceptual framework. A hierarchal approach was carried out using Poisson regressions. RESULTS: Older persons living in rural areas, those who reported brushing once a day or less and older persons with fewer natural teeth had an increased chance of reporting deterioration in oral health-related quality of life. Women and participants who received a minimum wage of less than US $219.50 were more likely to report improvement in oral health-related quality of life. CONCLUSION: The results of this study suggest that changes in the oral health-related quality of life are influenced by many of the variables that were included in the conceptual framework.

Untreated caries and serum vitamin D levels in children and youth of the United States: NHANES 2013-2014.

This study aimed to investigate the association between serum vitamin D levels and untreated caries and determining factors in children and youth. METHODOLOGY: This cross-sectional study used data from the National Health and Nutrition Examination Survey (2013-2014). In total, 3,072 participants with ages ranging from 1 to 19 years were included in our sample. The main dependent variable, untreated caries, was defined as having at least one untreated carious surface in any tooth. Serum concentration of 25-hydroxyvitamin D [25(OH)D] was categorized into four groups: ≥75 nmol/ml, 50-74.9 nmol/ml, 25-49.9 nmol/ml, and <25 nmol/ml. Data were analyzed using a binary logistic regression. RESULTS: For children aged 1-5 years, age (OR = 1.68, 95% confidence intervals (95% CI) 1.38-2.04) and low levels of vitamin D (25-49.9 nmol/ml, and <25 nmol/ml: OR = 2.55, 95% CI 1.06-6.13) were associated with untreated caries. For children aged 6-11 years, low levels of vitamin D (50-74.9 nmol/ml: OR=1.45, 95% CI 1.16-1.82) remained associated with untreated caries. No associations were found in those between 12 and 19 years of age. CONCLUSION: Our findings show an association between low levels of 25(OH)D and untreated caries in children between 1 and 11 years of age, suggesting that this nutrient might interfere in the caries process.

[Coverage of the Brazilian Income Transfer Program and factors associated with the performance of dental procedures in Brazil, from 2007 to 2011: an ecological study]. / Cobertura do Programa Bolsa Família e fatores associados à realização de procedimentos odontológicos no Brasil, entre 2007 e 2011: um estudo ecológico.

In Brazil, there has been an expansion of the coverage of dental services in primary health care (PHC), and the focus of the services has changed to include more efforts in prevention and diagnosis. However, little is known about the influence of the coverage of the Brazilian Income Transfer program on the use of dental services. Our study evaluates the association between municipal coverage of the Brazilian Income Transfer Program and the use of dental services. This ecological study conducted with data from the 5,570 Brazilian municipalities estimates, via logistic regressions, the impact of the coverage of the Brazilian Income Transfer program, the Family Health Strategies (FHS), and the oral health teams on the number of restoration, colective, prevention, and dental extraction procedures performed by the Brazilian Unified National Health System (SUS) between the periods 2007/2008 and 2010/2011. The percentage of municipalities that increased the rates of prevention, colective, restoration, and extraction procedures was 46%, 59.8%, 52.5%, and 44.2%, respectively. In the adjusted model, municipalities with increased coverage of Brazilian Income Transfer program were less likely to increase colective (OR = 0.91; 95%CI: 0.79-1.04) and prevention (OR = 0.92; 95%CI: 0.80-1.05) procedures, and they were more likely to increase rates of restoration (OR = 1.11; 95%CI: 0.97-1.28) and dental extraction (OR = 1,10; 95%CI: 0.95-1.27) procedures. The increase in the coverage rate of the oral health teams was significantly associated with a higher chance of an increase in prevention, restoration, and extraction procedures. We conclude that the coverage of oral health teams was the main variable associated with the increase in dental procedures performed in the public service.

No Brasil, houve expansão da cobertura de serviços odontológicos na atenção primária à saúde (APS), e a ênfase do trabalho dos profissionais mudou para incluir mais esforços na prevenção e no diagnóstico. Entretanto, pouco se sabe sobre a influência da cobertura do Programa Bolsa Família no uso desses serviços. Esta pesquisa avaliou a associação entre cobertura municipal do Programa Bolsa Família e uso de serviços odontológicos. Este estudo ecológico, realizado com dados dos 5.570 municípios brasileiros, estimou, por meio de regressões logísticas, o impacto da variação de cobertura do Programa Bolsa Família, das Estratégias Saúde da Família (ESF) e das equipes de saúde bucal (EqSB) no número de procedimentos odontológicos restauradores, coletivos, preventivos e exodontias realizados via Sistema Único de Saúde (SUS) entre os períodos 2007/2008 e 2010/2011. Os percentuais de municípios em que houve aumento das taxas de procedimentos preventivos, coletivos, restauradores e exodontias foram de 46%, 59,8%, 52,5% e 44,2%, respectivamente. No modelo ajustado, em municípios com maior cobertura do Bolsa Família houve menos chances de aumentar a ocorrência de procedimentos coletivos (OR = 0,91; IC95%: 0,79-1,04) e preventivos (OR = 0,92; IC95%: 0,80-1,05) e mais chances de elevar as taxas de procedimentos restauradores (OR = 1,11; IC95%: 0,97-1,28) e exodontias (OR = 1,10; IC95%: 0,95-1,27). A expansão na taxa de cobertura das EqSB esteve associada significativamente a uma chance maior de aumento do número de procedimentos preventivos, restauradores e exodontias. Conclui-se que a cobertura das EqSB foi a principal variável associada à ampliação da quantidade de procedimentos odontológicos realizados no serviço público.

En Brasil, hubo una expansión de la cobertura de servicios odontológicos en la atención primaria a la salud, y el énfasis del trabajo de los profesionales cambió para incluir más esfuerzos en la prevención y en el diagnóstico. Sin embargo, poco se sabe sobre la influencia de la cobertura del Programa Bolsa Familia en el uso de los servicios odontológicos. El presente estudio evaluó la asociación entre la cobertura municipal del Programa Bolsa Familia y uso de servicios odontológicos. Un estudio ecológico realizado con datos de los 5.570 municipios brasileños estimó, a través de regresiones logísticas; el impacto de la variación de cobertura del Programa Bolsa Familia, de las Estrategias de Salud de la Familia (ESF) y de los equipos de salud bucal (EqSB) en el número de procedimientos odontológicos restauradores, colectivos, preventivos y exodoncias realizados a través del Sistema Único de Salud (SUS) entre los períodos 2007/2008 y 2010/2011. El porcentaje de municipios que aumentaron las tasas de procedimientos preventivos, colectivos, restauradores y exodoncias fue del 46 %, 59,8 %, 52,5 % y 44,2 %, respectivamente. En el modelo ajustado, los municipios con aumento de la cobertura de Programa Bolsa Familia tuvieron menos probabilidades de aumentar procedimientos colectivos (OR = 0,91; IC95%: 0,79-1,04), y preventivos (OR = 0,92; IC95%: 0,80-1,05), y más probabilidades de aumentar las tasas de procedimientos restauradores (OR = 1,11; IC95%: 0,97-1,28) y exodoncias (OR = 1,10; IC95%: 0,95-1,27). El aumento en la tasa de cobertura de EqSB se asoció significativamente con una mayor probabilidad de aumento en procedimientos preventivos, restauradores y exodoncias. Se concluye que la cobertura de las EqSB fue la principal variable asociada al aumento de los procedimientos odontológicos realizados en el servicio público.

Feedback on audit and action planning for dental caries control: a qualitative study to investigate the acceptability among interdisciplinary pediatric dental care teams.

Introduction: American Indian and Alaska Native children suffer from the poorest oral health of all populational groups in the United States. Evidence-based practices (EBP) for caries control are well established, but systematically implementing such practices have proven difficult. Audit and feedback with goal setting, and action planning to implement these EBPs have not been tested or adapted for Alaska Native healthcare settings. The aim of this study was to investigate acceptability and perceived feasibility of an audit and feedback intervention for pediatric dental caries control among dental providers and patient stakeholders. Methods: The pilot program was implemented in two dental clinics from a tribal healthcare consortium in Alaska. Key-informant interviews were conducted to investigate the contextual, organizational, and behavioral facilitators and barriers to the implementation and expansion of the program. Interview transcripts were analyzed by two researchers using thematic analysis. Results: Eight key informants were interviewed twice (during and after the intervention period), and one once, for a total of 17 interviews. Patient stakeholders were not interviewed due to COVID-19 pandemic clinic closures and social isolation mandates. Three principal themes emerged: a positive organizational climate and culture fostered the acceptability of the program, the positive impacts of the program observed in the pediatric dental teams and the organization, and the challenges to implement the program including understanding the data reports, trusting the accuracy of the data, and competing priorities. Conclusions: The intervention of audit and feedback with goal setting and action planning was well accepted and perceived as feasible by the study participants given the financial and human resources provided by the research project. This qualitative study can inform the design and evaluation of process-oriented implementation strategies geared towards decreasing health inequities and improving health outcomes, such as dental caries in American Indian and Alaska Native children and adolescents.

Association between cash transfer programs and oral health-A scoping review.

OBJECTIVES: The aims of this scoping review are to assess the literature investigating the association between cash transfer programs and oral health; and to identify the theoretical frameworks applied to guide this literature. METHODS: A search strategy to identify studies published until December 2020 was applied to a range of databases. Observational and interventional studies that had cash transfer programs as exposure/intervention and oral health as outcome were considered. Dental health services utilization, as well as access to dental health services, were considered secondary outcomes. Cash transfer programs were considered programs based on conditional or unconditional cash transfer carried out as part of national social protection schemes, and interventional studies on the impact of cash transfer on oral health were also considered eligible. Data charting was performed in two steps and a narrative synthesis was conducted. RESULTS: Of 6344 articles identified, four articles were included. These articles investigated three different conditional cash transfer programs, Universal Child Allowance (Argentina), Bolsa Família (Brazil) and Family Rewards (USA). Inconsistencies were identified in findings on the effect of conditional cash transfer programs on the prevalence of dental caries and these differences may be due to the comparison group selected for each study. Concerning dental visits, the results point in different directions, which makes these findings still inconclusive. No explicit theoretical framework was reported in the articles to guide the expected association. CONCLUSION: Although cash transfers play an important role in improving certain health outcomes, there is limited evidence to suggest an association between cash transfers and oral health.

Pathways that explain racial differences on edentulism among older adults: 2019 Brazil National Health Survey.

This study aimed to evaluate the pathways that explain the association between race/skin color and edentulism in elderly Brazilians. This was a cross-sectional study using data from participants aged 60 years or older from the 2019 Brazilian National Health Survey, a nationally representative population-based sample. Data were obtained by a structured interview and participants were classified as edentulous if they reported having lost all natural teeth. Information on race, socioeconomic level, behavioral aspects, psychosocial aspects, and access to dental care was collected by interviewers using a questionnaire. The pathways between race/skin color and edentulism were analyzed using structural equation modeling. The final sample of the study included 22,357 participants. Most participants were white (51.5%; 95% confidence interval [CI]: 50.3-52.6), and 36.8% (95%CI: 35.7-37.9) were edentulous. Race/skin color was indirectly associated with edentulism via enabling factors. These findings suggest that socioeconomic inequalities are key in explaining racial inequalities in edentulism among Brazilian older adults.

[The use of dental services in the past year in the brazilian population: a systematic review with meta-analysis]. / O uso dos serviços odontológicos no último ano na população brasileira: revisão sistemática com metanálise.

The scope of this study was to analyze the factors associated with the use of dental services in Brazil. The review strategy included PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS and Google Scholar databases, in addition to repositories and databases of dissertations and theses. Studies were selected using the PEO (Population/Exposure/Outcomes) strategy. The outcome of this study was the use of dental services in the last year by the Brazilian population, treated as dichotomous variables for the following analyses: ≤ 1 year and > 1 year. Mantel-Haenszel random effect meta-analysis was performed, estimating Prevalence Ratios (PR) and 95% confidence intervals (95%CI). A total of 94 studies were selected. The majority (98%) had a cross-sectional design, with 63% derived from primary data. For the meta-analysis, 25 studies were included. The use of oral health services in the last year was associated with higher education (≥ 8 years of schooling) (PR = 0.49, (95%CI: 0.39-0.60)); higher family income (≥ 2 minimum wages) (RP = 0.79, (95%CI: 0.74-0.84)); and living in urban areas (RP = 0.79, (95%CI: 0.64-0.97)). The availability of dental services in the Unified Health System needs to be made readily accessible to people with lower income, less education and those living in rural areas.

O objetivo foi analisar os fatores associados ao uso dos serviços odontológicos no Brasil. A estratégia de revisão incluiu as bases PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS e Google Scholar, além de repositórios e bancos de dissertações e teses. Os estudos foram selecionados ​​usando a estratégia PEO (população/exposição/desfechos). O desfecho deste estudo foi o uso dos serviços odontológicos no último ano pela população brasileira, tratado como variáveis dicotômicas para as análises: ≤ 1 ano e > 1 ano. Foi realizada uma metanálise de efeito randômico de Mantel-Haenszel, estimando-se razões de prevalência (RP) e intervalos de confiança de 95% (IC95%). Foram selecionados 94 estudos. A maioria (98%) tinha delineamento transversal, sendo 63% oriundos de dados primários. Para a metanálise, 25 estudos foram incluídos. O uso dos serviços odontológicos no último ano esteve associado com maior escolaridade (≥ 8 anos de estudo) (RP = 0,49, (IC95%: 0,39-0,60)); maior renda familiar (≥ 2 salários-mínimos) (RP = 0,79, (IC95%: 0,74-0,84)); e residir na zona urbana (RP = 0,79, (IC95%: 0,64-0,97)). A oferta de serviços odontológicos no Sistema Único de Saúde precisa ser ampliada entre pessoas com menor renda, menor escolaridade e moradores da zona rural.