Use of dental services by the Brazilian elderly: latent class analysis. / Utilização dos serviços odontológicos por idosos brasileiros: análise de classes latentes.

OBJECTIVE: To analyze the different profiles of dental service use by the Brazilian elderly and their possible association with sociodemographic factors, comorbidities, functionality and self-perception of oral health. METHODS: Cross-sectional population-based study, using secondary data from the National Health Survey (PNS) of 2013. The sample size was 2,969 elderly individuals. Latent Class Analysis was used to construct the dependent variable "profile of dental service use" from questions related to this profile. The independent variables formed 3 blocks: sociodemographic; comorbidities; functionalities and self-perception of oral health. The Rao-Scott Test and Standardized Residue Analysis tested the association. To measure the effect of covariates, Odds Ratio was estimated using a multiple hierarchical model of multinomial logistic regression. Significance level was 5%. RESULTS: Three latent classes were identified: Direct Disbursement Profile, Health Plan Profile and the Unified Health System (SUS) Profile. White elderly people were associated with the Direct Disbursement and Health Plans profile. The Health Plan profile was more associated with the married marital status or living with a spouse. In the multiple model, low schooling was associated with the profile of SUS users and elderly people diagnosed with cancer with the Health Plan profile. Self-perceiving oral health as bad or very bad increased the chances of belonging to the SUS profile. CONCLUSION: Latent Class Analysis proved to be a powerful strategy for a subtle and detailed understanding of the profile of dental service use and its relationship with associated factors.

OBJETIVO: Analisar os diferentes perfis de utilização de serviços odontológicos por idosos brasileiros e sua possível associação com fatores sociodemográficos, de comorbidades, de funcionalidade e autopercepção em saúde bucal. MÉTODOS: Estudo transversal de base populacional, utilizando dados secundários da Pesquisa Nacional de Saúde de 2013. A amostra foi composta de 2.969 idosos. A Análise de Classes Latentes foi utilizada para a construção da variável dependente "perfil de utilização dos serviços odontológicos". As variáveis independentes formaram três blocos: sociodemográfico; comorbidades; e funcionalidades e autopercepção em saúde bucal. O Teste de Rao-Scott e a Análise de Resíduos Padronizados testaram a associação. Para mensurar o efeito das covariáveis, foram estimadas as odds ratios por meio de modelo múltiplo hierarquizado de regressão logística multinomial. O nível de significância foi de 5%. RESULTADOS: Três classes latentes foram identificadas: perfil de desembolso direto, perfil de plano de saúde e perfil do Sistema Único de Saúde (SUS). Idosos da cor branca apresentaram associação aos perfis desembolso direto e planos de saúde. O perfil plano de saúde esteve mais associado ao estado civil casado ou que moram com cônjuge. No modelo múltiplo, a baixa escolaridade apresentou associação ao perfil de usuários do SUS, e idosos com diagnóstico de câncer, ao perfil plano de saúde. Autoperceber a saúde bucal como ruim ou muito ruim aumentou a chance de pertencer ao perfil SUS. CONCLUSÃO: A Análise de Classes Latentes mostrou-se potente estratégia para compreensão sutil e detalhada do perfil da utilização de serviços odontológicos e sua relação com fatores associados.

Tooth loss in Brazilian middle-aged adults: multilevel effects.

OBJECTIVE: To examine the link between tooth loss and multilevel factors in a national sample of middle-aged adults in Brazil. MATERIAL AND METHODS: Analyses were based on the 2003 cross-sectional national epidemiological survey of the oral health of the Brazilian population, which covered 13 431 individuals (age 35-44 years). Multistage cluster sampling was used. The dependent variable was tooth loss and the independent variables were classified according to the individual or contextual level. A multilevel negative binomial regression model was adopted. RESULTS: The average tooth loss was 14 (standard deviation 9.5) teeth. Half of the individuals had lost 12 teeth. The contextual variables showed independent effects on tooth loss. It was found that having 9 years or more of schooling was associated with protection against tooth loss (means ratio range 0.68-0.76). Not having visited the dentist and not having visited in the last > or =3 years accounted for increases of 33.5% and 21.3%, respectively, in the risk of tooth loss (P < 0.05). The increase in tooth extraction ratio showed a strong contextual effect on increased risk of tooth loss, besides changing the effect of protective variables. CONCLUSIONS: Tooth loss in middle-aged adults has important associations with social determinants of health. This study points to the importance of the social context as the main cause of oral health injuries suffered by most middle-aged Brazilian adults.

Self-perception of oral health by indigenous people: an analysis of latent classes. / Autopercepção da saúde bucal por indígenas: uma análise de classes latentes.

Given the limited comprehension of the indigenous oral health profile, this study proposed to understand the self-perception of oral health of this population group. This study aimed to verify the association of oral health's self-perceived impact on daily living with sociodemographic and oral health characteristics among indigenous people aged 10 to 14 years of the Xukuru do Ororubá ethnic group, in Pesqueira (PE), Brazil. This is a cross-sectional study conducted from January to March 2010, involving oral examinations and questionnaires applied to 233 indigenous belonging to the age group. Using the latent class analysis model, the variable "oral health impact" was created and applied to simple and multiple logistic regression models. The results pointed out that villages with the highest mean of households and indigenous people with caries experience evidenced worse self-perception, increasing the "oral health impact" 2.37 and 3.95 times, respectively. The Latent Class Analysis was an excellent strategy for understanding the self-perception of indigenous oral health and its relationship with associated factors.

Dada a limitada compreensão do perfil de saúde bucal de indígenas, este estudo se propôs a investigar a autoavaliação da saúde bucal desse grupo populacional. Objetivou-se verificar a associação do impacto autopercebido da saúde bucal na vida diária com aspectos sociodemográficos e de caracterização da saúde bucal entre indígenas de 10 a 14 anos da etnia Xukuru do Ororubá, Pesqueira ­ PE, Brasil. Trata-se de um estudo transversal desenvolvido no período de janeiro a março de 2010, com realização de exames bucais e aplicação de questionários a 233 indígenas pertencentes ao grupo etário. Por meio do modelo de análise de classes latentes, a variável "impacto da saúde bucal" foi criada e aplicada em modelos de regressão logística simples e múltipla. Os resultados apontaram que aldeias com maior média de domicílios e indígenas com experiência de cárie apresentaram pior autopercepção, aumentando o "impacto da saúde bucal" em 2,37 e 3,95 vezes respectivamente. A Análise de Classes Latentes mostrou-se uma excelente estratégia para compreensão da autopercepção bucal indígena e sua relação com fatores associados.

Factors associated with the need for a complete denture in one arch or both arches among the elderly population.

This study aimed to identify factors associated with the need for complete dentures in one dental arch or both, among the elderly population. The cross-sectional household study was conducted with a representative sample of elderly people (65 years or older) in the state of São Paulo, Brazil, in 2015. The dependent variable was the need for complete dentures (in one arch or both), and independent variables were socioeconomic and demographic conditions, social capital, self-perception of oral health and access to dental services. Simple and multinomial logistic regression models tested effect measures (p < 0.05). A total of 5,948 elderly people participated. Results indicated that those with greater chances of needing a complete denture in one arch were male (OR = 1.54; CI95%:1.04-2.29), with fewer household goods (OR = 2.25; CI95%:1.50-3.38), lower monthly household income: R$501-1500 (OR = 3.44; CI95%:1.27-9.35), R$1501-2500 (OR = 4.11; CI95%:1.50-11.27), R$2501-4500 (OR = 2.76; CI95%:1.10-6.95), self-reported need for a complete denture (OR = 4.75; CI95%:3.08-7.35), ≥3 years since last dental appointment (OR = 1.80; CI95%:1.06-3.05), and dissatisfaction with last dental appointment (OR = 1.80; CI95%:1.06-3.05). There were more chances of the need for complete dentures in both arches among older elders (OR = 1.44; CI95%:1.06-1.88), with lower monthly household income: R$ < 501 (OR = 4.45; CI95%:1.71-11.60), R$501-1500 (OR = 4.01; CI95%:2.14-7.51), R$1501-2500 (OR = 2.95; CI95%:1.64-5.32), < 3 years of education (OR = 1.45; CI95%:1.13-1.85), feeling unhappy (OR = 2.74; CI95%:1.35-5.57), self-reported need for a complete denture (OR = 8.48; CI95%:5.75-12.50), dissatisfaction with their mouth (OR = 2.38; CI95%:1.64-3.46), ≥3 years since last dental appointment (OR = 4.28; CI95%:2.85-6.43), and dissatisfaction with last dental appointment (OR = 4.28; CI95%:2.85-6.43). The several dimensions of the determinants of the need for a complete denture reflect the influence of both demographic and socioeconomic aspects, social capital, self-perception of oral health and access to dental services.

Evaluation of the quality of oral health care in Primary Health Care in Pernambuco, Brazil, 2014. / Avaliação da qualidade da assistência em saúde bucal na Atenção Primária à Saúde em Pernambuco, 2014.

OBJECTIVE: to evaluate the quality of oral health care in Primary Health Care services in Pernambuco state, Brazil, 2014. METHODS: this was an ecological health evaluation study based on the Donabedian model, involving secondary data from the 2nd cycle of the National Program for Improving Access and Quality of Primary Health Care (PMAQ-AB); comparison between the structure, process and outcome variables was done using the Kruskal-Wallis test (p<0.050); variables showing statistical significance (p<0.05) were portrayed through thematic and spatial dependence maps. Results: the standard of quality in the municipalities for the 'Structure' dimension gained better scores than the 'Work process' dimension; correlations were identified between the indicators for dental urgency, supervised tooth brushing coverage and treatments completed, in quality strata related to the work process of the Oral Health teams. CONCLUSION: organization of the work process was seen to be a determining factor in the impact on some indicators of service use.

Avaliação da qualidade da atenção em saúde bucal na estratégia saúde da família de Recife, Pernambuco, 2014 / Assessing the quality of oral health care in the family health strategy in Recife, Pernambuco, 2014

Resumo Introdução Há escassos estudos sobre qualidade da atenção em saúde bucal. Objetivo Avaliar associações entre condições de estrutura e processo com indicadores de desempenho em saúde bucal na Estratégia Saúde da Família do Recife. Métodos Estudo transversal, quantitativo e avaliativo, usando dados secundários de 2014 do Ministério da Saúde. Foram calculados testes de Qui-Quadrado e estimativas de Odds Ratio, com regressão logística simples e múltipla, considerando nível de significância de 5% e intervalo de confiança de 95%. Resultados Das 112 equipes de saúde bucal (ESB) avaliadas, equiparação das ESB com as equipes mínimas da Estratégia Saúde da Família e possuir levantamento de escolares com necessidades de saúde bucal, associaram-se ao maior valor de cobertura de primeira consulta odontológica programática (OR = 4,30, IC = 1,33−13,93; OR = 27,47, IC = 2,24−336,34, respectivamente), enquanto estar equiparada, ser ESB modalidade II e garantir agendamento de retorno para a continuidade do tratamento associaram-se ao maior valor da razão entre tratamentos concluídos e primeiras consultas odontológicas programáticas (OR = 5,35, IC = 2,01−14,20; OR = 3,70, IC =1,33−10,27; OR = 5,03, IC = 1,42−17,78, respectivamente). Conclusão Os resultados sugerem que tais padrões de qualidade sejam priorizados para potencializar maior acesso e resolutividade das ESB.

Abstract Background Only a few studies have addressed the quality of oral health care. Objective To assess the association of the structure and process conditions with oral health performance indicators in the Family Health Strategy of Recife. Method A cross-sectional quantitative and evaluative study based on secondary data referring to 2014 from the Ministry of Health. The Chi-Square test and the Odds Ratio, with simple and multiple regression, were calculated considering a significance level of 5% and confidence interval of 95%. Results Among the 112 oral health teams (OHT) assessed, there was an association of the OHT parity with the minimum Family Health Strategy teams and the survey of schoolchildren with oral health needs with the highest coverage value of the first dental programmatic appointment (OR = 4.30 = CI = 1.33-13.93, OR = 27.47, IC = 2.24-336.34, respectively). In turn, the presence of parity, modality II OHT, and scheduled guarantee return for the treatment continuity were associated with the highest ratio between completed treatment and first dental appointment (OR = 5.35, CI = 2.01-14.20; OR = 3.70, CI = 1,33-10,27; OR = 5,03, CI = 1,42-17,78, respectively). Conclusion The results suggest the targeting of such quality standards to enhance both the access and resilience of the OHT.

Implementação do Programa Saúde na Escola: relação com aspectos da saúde bucal dos estudantes / Implementation of the School Health Program: relationship with aspects of students' oral health

RESUMO O estudo objetivou investigar a associação entre a implementação do Programa Saúde na Escola (PSE) e aspectos relacionados com a saúde bucal de adolescentes escolares que frequentam escolas públicas no Brasil. Foi realizado estudo transversal exploratório utilizando dados da Pesquisa Nacional de Saúde Escolar (PeNSE) 2015 em uma amostra de 81.154 estudantes de 13 a 15 anos frequentando escolas públicas das capitais, Distrito Federal e interior. Os dados foram obtidos por meio de questionários respondidos pelos alunos e responsáveis pelas escolas. Foi realizada análise bivariada de associação entre a variável 'implementação das ações do PSE pela escola' (Sim/Não) e aspectos relativos à saúde bucal dos estudantes. Em comparação com escolas sem implementação do PSE, as que haviam implementado o Programa apresentavam melhores indicadores de comportamento (consumo de alimentos com açúcar adicionado, cigarro e álcool); venda de alimentos saudáveis ou com açúcar adicionado; existência de grupo/comitê de saúde, ações do Programa Mais Educação e ações em conjunto com a Unidade Básica de Saúde (p<0,05). Concluiu-se que houve associação entre a implementação do PSE e aspectos mais favoráveis relacionados com a saúde bucal, referentes a alimentação, uso de cigarro e álcool entre os escolares, e ações de saúde e educação nas escolas.

ABSTRACT This study aimed to investigate the association between the School Health Program (PSE) implementation and aspects related to the oral health of adolescent students attending public schools in Brazil. An exploratory cross-sectional study was conducted using data from the 2015 National School Health Survey (PeNSE) in a sample of 81,154 students aged 13 to 15 in the capitals, Federal District, and inland cities. Data were retrieved from questionnaires answered by students and those responsible for the schools. We performed a bivariate analysis of the association between the variable 'implementation of PSE actions by the school' (Yes/No) and aspects related to the students' oral health. Compared to schools without PSE implementation, those that had implemented the Program had better behavioral indicators (consumption of sugar-added foods, cigarettes, and alcohol); selling healthy or sugar-added foods; availability of a health group/committee, and actions of the More Education Program and with Primary Health Care Units (p<0.05). We concluded that there was an association between the implementation of the PSE and more favorable aspects related to oral health regarding the students' diet, tobacco use, and alcohol consumption, and school health and education actions.

Satisfaction of caregivers and older adults who use the Better at Home Program / Satisfação dos cuidadores e dos idosos usuários do Programa Melhor em Casa

ABSTRACT OBJECTIVE Evaluate the satisfaction of caregivers and older adults who use the home care service provided by the Better at Home Program (Programa Melhor em Casa) and its associated factors. METHODS This is a cross-sectional study with data from the national survey on the Better at Home Program, conducted by the SUS General Ombudsman. We interviewed 5,595 caregivers and 950 older adults. We combined four questions related to satisfaction to formulate the dependent variable by means of latent class analysis and used 13 questions as independent variables. RESULTS 93.7% of the older adults and 90.2% of the caregivers were satisfied with the service. In the multiple analysis, the variables showing association with satisfaction were: also being accompanied by a family health team (older adults: OR = 4.22; p = 0.014), shorter time between referral and the first visit (older adults: OR = 10.20; p = 0.006), (caregiver: OR = 5.84; p < 0.001), taking examinations with medical requirement (older adults: OR = 5.74; p = 0.037), (caregiver: OR = 7.41; p < 0.001), consultation with specialist (caregiver: OR = 6.02; p < 0.001), visits out of the schedule when necessary (older adults: OR = 8.09; p = 0.014), (caregiver: OR = 1.81; p = 0.015) and understanding the orientations provided by the program team (caregiver: OR = 10.61; p < 0.001). CONCLUSIONS The majority of the older adults and caregivers showed satisfaction with the program, with a distinction in the aspects associated with this satisfaction, in which only the characteristics directly related to the program influenced the satisfaction, while the same did not occur with the socioeconomic and demographic characteristics.

RESUMO OBJETIVO Avaliar a satisfação dos cuidadores e dos idosos usuários do serviço de atenção domiciliar por meio do Programa Melhor em Casa e seus fatores associados. METÓDOS Trata-se de um estudo transversal com dados da pesquisa nacional sobre o Programa Melhor em Casa, conduzida pela Ouvidoria Geral do SUS. Foram entrevistados 5.595 cuidadores e 950 idosos. Quatro perguntas relacionadas à satisfação foram unidas para formulação da variável dependente por meio da análise de classes latentes e 13 perguntas foram utilizadas como variáveis independentes. RESULTADOS Mostraram-se satisfeitos com o serviço, 93,7% dos idosos e 90,2% dos cuidadores. Na análise múltipla, as variáveis que apresentaram associação com a satisfação foram: também ser acompanhados por uma equipe de saúde da família (idoso: OR = 4,22; p = 0,014), menor tempo entre o encaminhamento e a primeira visita (idoso: OR = 10,20; p = 0,006), (cuidador: OR = 5,84; p < 0,001), realização de exames quando havia solicitação médica (idoso: OR = 5,74; p = 0,037), (cuidador: OR = 7,41; p < 0,001), realização de consulta com especialista (cuidador: OR = 6,02; p < 0,001), ter visitas fora do horário agendado quando fosse necessário (idoso: OR = 8,09; p = 0,014), (cuidador: OR = 1,81; p = 0,015) e compreender as orientações que eram passadas pela equipe do programa (cuidador: OR = 10,61; p < 0,001). CONCLUSÕES Constatou-se que a maioria dos idosos e dos cuidadores demonstraram satisfação com o programa, havendo distinção nos aspectos associados a essa satisfação, nos quais apenas as características diretamente relacionadas ao programa influenciaram na satisfação, não ocorrendo o mesmo com as características socioeconômicas e demográficas.

Atenção em Saúde Bucal do município de Recife: avaliação pós-adesão ao Programa Nacional de Melhoria do Acesso e da Qualidade de Atenção Básica / Oral Health Care in the municipality of Recife: evaluation after adherence to the National Program for Improving Access and Quality of Primary Care

Este estudo objetivou avaliar condições de estrutura e processo da atenção em saúde bucal na Estratégia Saúde da Família (ESF) do município de Recife, durante o segundo ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Realizou-se um estudo transversal, quantitativo e avaliativo com as 112 equipes de saúde bucal (ESB) do município que participaram da avaliação externa do Programa, em 2014. Os dados foram coletados a partir das informações disponibilizadas pelo Ministério da Saúde, sendo submetidos à estatística descritiva. Os resultados evidenciaram 32,1% ESB equiparadas às equipes mínimas da ESF (EqSF); 70,5% cirurgiões-dentistas indicaram ter Plano de Carreira e 95,5% tinham e/ou estavam em formação complementar. Todas ESB participavam de reuniões da EqSF; 93,8% ofertam consulta odontológica de demanda espontânea e agendada. Destas, 83% garantiam agendamento de retorno. A oferta de consultas odontológicas especializadas foi identificada como disponível por 97,3% das ESB, mas apenas 50,9% afirmaram ter fluxo de comunicação institucionalizado com especialistas. Todas ESB realizavam o acompanhamento de gestantes e o atendimento de crianças até 5 anos de idade. Conclui-se que a maioria das equipes avaliadas apresentou adequação ao maior contingente das condições de estrutura e processo da atenção em saúde bucal estudados.

This study aimed to evaluate the structure and process conditions of oral health care in the Family Health Strategy (FHS) of Recife, during the second cycle of the National Program for Improving Access and Quality of Primary Care. A cross- sectional, quantitative and evaluative study was carried out with the 112 oral health teams (OHT) of the municipality that participated in the external evaluation of the program in 2014. Data were obtained by the Ministry of Health and submitted to descriptive statistics. The results indicate that 32.1% of the OHT equated to the minimum teams of the FHS (TFHS); 70.5% of the dentists indicated having a Career Plan and 95.5% had and/or were in complementary training. All the OHT attended meetings with the TFHS; 93.8% offered dental consultation of spontaneous and scheduled demand. Of these, 83% guaranteed return scheduling. The offer of specialized dental appointments was identified as available by 97.3% of the OHT, but only 50.9% reported having an institutionalized communication flow with specialists. All the OHT performed the monitoring of pregnant women and the care of children up to 5 years old. It was concluded that most of the teams presented adequacy to the largest contingent of structure and process conditions of the oral health care studied.

Utilização dos serviços odontológicos por idosos brasileiros: análise de classes latentes / Use of dental services by the Brazilian elderly: latent class analysis

RESUMO: Objetivo: Analisar os diferentes perfis de utilização de serviços odontológicos por idosos brasileiros e sua possível associação com fatores sociodemográficos, de comorbidades, de funcionalidade e autopercepção em saúde bucal. Métodos: Estudo transversal de base populacional, utilizando dados secundários da Pesquisa Nacional de Saúde de 2013. A amostra foi composta de 2.969 idosos. A Análise de Classes Latentes foi utilizada para a construção da variável dependente "perfil de utilização dos serviços odontológicos". As variáveis independentes formaram três blocos: sociodemográfico; comorbidades; e funcionalidades e autopercepção em saúde bucal. O Teste de Rao-Scott e a Análise de Resíduos Padronizados testaram a associação. Para mensurar o efeito das covariáveis, foram estimadas as odds ratios por meio de modelo múltiplo hierarquizado de regressão logística multinomial. O nível de significância foi de 5%. Resultados: Três classes latentes foram identificadas: perfil de desembolso direto, perfil de plano de saúde e perfil do Sistema Único de Saúde (SUS). Idosos da cor branca apresentaram associação aos perfis desembolso direto e planos de saúde. O perfil plano de saúde esteve mais associado ao estado civil casado ou que moram com cônjuge. No modelo múltiplo, a baixa escolaridade apresentou associação ao perfil de usuários do SUS, e idosos com diagnóstico de câncer, ao perfil plano de saúde. Autoperceber a saúde bucal como ruim ou muito ruim aumentou a chance de pertencer ao perfil SUS. Conclusão: A Análise de Classes Latentes mostrou-se potente estratégia para compreensão sutil e detalhada do perfil da utilização de serviços odontológicos e sua relação com fatores associados.

ABSTRACT: Objective: To analyze the different profiles of dental service use by the Brazilian elderly and their possible association with sociodemographic factors, comorbidities, functionality and self-perception of oral health. Methods: Cross-sectional population-based study, using secondary data from the National Health Survey (PNS) of 2013. The sample size was 2,969 elderly individuals. Latent Class Analysis was used to construct the dependent variable "profile of dental service use" from questions related to this profile. The independent variables formed 3 blocks: sociodemographic; comorbidities; functionalities and self-perception of oral health. The Rao-Scott Test and Standardized Residue Analysis tested the association. To measure the effect of covariates, Odds Ratio was estimated using a multiple hierarchical model of multinomial logistic regression. Significance level was 5%. Results: Three latent classes were identified: Direct Disbursement Profile, Health Plan Profile and the Unified Health System (SUS) Profile. White elderly people were associated with the Direct Disbursement and Health Plans profile. The Health Plan profile was more associated with the married marital status or living with a spouse. In the multiple model, low schooling was associated with the profile of SUS users and elderly people diagnosed with cancer with the Health Plan profile. Self-perceiving oral health as bad or very bad increased the chances of belonging to the SUS profile. Conclusion: Latent Class Analysis proved to be a powerful strategy for a subtle and detailed understanding of the profile of dental service use and its relationship with associated factors.

Formação ampliada durante residência multiprofissional em saúde: relato de experiência de um cirurgião-dentista com o povo Xukuru do Ororubá (Pernambuco/Brasil) / Formación ampliada durante residencia multiprofesional en salud: relato de experiencia de un cirujano dentista con el pueblo Xukuru del Ororubá (Pernambuco/Brasil) / Expanded education during health multiprofessional residency: the experience report of a dentist in the Xukuru do Ororubá indigenous people (Pernambuco/Brazil)

A partir das recomendações sobre experiências que aproximam a formação em saúde da realidade de populações em situação de vulnerabilidade, apresenta-se um relato de experiência, na perspectiva de um trabalhador residente em saúde, sobre a vivência de estágio no Território Indígena Xukuru do Ororubá (Pernambuco/Brasil). Emergiram reflexões sobre as condições de vida e saúde do povo indígena, o processo pedagógico de estágio e repercussões na formação e no fazer profissional, além das fragilidades relacionadas à cobertura e longitudinalidade do cuidado em saúde bucal. Por meio de intervenções com a perspectiva de autonomia dos sujeitos, foi possível aprimorar o olhar sociopolítico à questão indígena. Aponta-se a potencialidade da proposta, que estimula o confronto entre saberes profissionais instituídos e a realidade objetiva das comunidades, buscando superar o modelo colonial de cuidado, ampliando a perspectiva de atuação do profissional em formação para o Sistema Único de Saúde (SUS). (AU)

A partir de las recomendaciones sobre experiencias que aproximan la formación en salud de la realidad de poblaciones en situación de vulnerabilidad, se presenta un relato de experiencia, desde la perspectiva de un trabajador residente de salud, sobre la experiencia de pasantía en el Territorio Indígena Xukuru del Ororubá (Pernambuco/Brasil). Surgieron reflexiones sobre las condiciones de vida y salud del pueblo indígena, el proceso pedagógico de la pasantía y las repercusiones en la formación y el quehacer profesional, además de las fragilidades relacionadas con la cobertura y longitudinalidad del cuidado de salud bucal. Por medio de intervenciones con la perspectiva de autonomía de los sujetos, fue posible perfeccionar la mirada sociopolítica sobre la cuestión indígena. Se señala la potencialidad de la propuesta que incentiva el enfrentamiento entre saberes profesionales instituidos y la realidad objetiva de las comunidades, buscando la superación del modelo colonial de cuidado, ampliando la perspectiva de actuación del profesional en formación para el Sistema Brasileño de Salud (SUS). (AU)

This is an experience report, based on the recommendations that call to close the gap between health education and the reality of populations in vulnerable situations, from the perspective of a residence worker, about the internship experience in the Xukuru do Ororubá Indigenous Territory (Pernambuco/Brazil). The observations emerged regarding the living and health conditions of the indigenous people, the internship pedagogical process and its repercussions on professional training and practice, as well as the weaknesses related to the coverage and longitudinality of oral health care. It was possible to improve the socio-political glance at the indigenous issue through interventions from the perspective of subject autonomy. The potentiality of the proposal is evident, stimulating the confrontation between established professional knowledge and the objective reality of the communities, seeking to overcome the colonial model of care, expanding the perspective of professional training for the Brazilian National Health System (SUS). (AU)

[Oral health of Brazilian elderly: a systematic review of epidemiologic status and dental care access]. / A saúde bucal do idoso brasileiro: revisão sistemática sobre o quadro epidemiológico e acesso aos serviços de saúde bucal.

Population aging and declining birth rate have significantly altered the Brazilian age structure pyramid. In parallel with demographic transition, epidemiological transition is altering morbidity-mortality profiles, without adequate health support for the elderly population group. By searching databases, the objective of this study was a systemic literature review from 1986 to 2004 concerning the most prevalent oral problems experienced by elderly Brazilians, aimed at revealing the main obstacles for accessing health services. Mean DMFT index values in this study ranged from 25 to 31. Most articles reported a high percentage of edentulism. The main barriers for access to dental services were poor education, low income, and scarcity of public oral health services. Brazilian elderly oral health is thus precarious, with high edentulism rates, periodontal problems, decayed teeth, and great need for prostheses, reflecting the historical inefficacy of public dental services, limited to serial extractions and emergency services, based on the curative model.

Autopercepção da saúde bucal por indígenas: uma análise de classes latentes / Self-perception of oral health by indigenous people: an analysis of latent classes

Resumo Dada a limitada compreensão do perfil de saúde bucal de indígenas, este estudo se propôs a investigar a autoavaliação da saúde bucal desse grupo populacional. Objetivou-se verificar a associação do impacto autopercebido da saúde bucal na vida diária com aspectos sociodemográficos e de caracterização da saúde bucal entre indígenas de 10 a 14 anos da etnia Xukuru do Ororubá, Pesqueira - PE, Brasil. Trata-se de um estudo transversal desenvolvido no período de janeiro a março de 2010, com realização de exames bucais e aplicação de questionários a 233 indígenas pertencentes ao grupo etário. Por meio do modelo de análise de classes latentes, a variável "impacto da saúde bucal" foi criada e aplicada em modelos de regressão logística simples e múltipla. Os resultados apontaram que aldeias com maior média de domicílios e indígenas com experiência de cárie apresentaram pior autopercepção, aumentando o "impacto da saúde bucal" em 2,37 e 3,95 vezes respectivamente. A Análise de Classes Latentes mostrou-se uma excelente estratégia para compreensão da autopercepção bucal indígena e sua relação com fatores associados.

Abstract Given the limited comprehension of the indigenous oral health profile, this study proposed to understand the self-perception of oral health of this population group. This study aimed to verify the association of oral health's self-perceived impact on daily living with sociodemographic and oral health characteristics among indigenous people aged 10 to 14 years of the Xukuru do Ororubá ethnic group, in Pesqueira (PE), Brazil. This is a cross-sectional study conducted from January to March 2010, involving oral examinations and questionnaires applied to 233 indigenous belonging to the age group. Using the latent class analysis model, the variable "oral health impact" was created and applied to simple and multiple logistic regression models. The results pointed out that villages with the highest mean of households and indigenous people with caries experience evidenced worse self-perception, increasing the "oral health impact" 2.37 and 3.95 times, respectively. The Latent Class Analysis was an excellent strategy for understanding the self-perception of indigenous oral health and its relationship with associated factors.

Dental fluorosis: prevalence and associated factors in 12-year-old schoolchildren in Goiânia, Goiás.

OBJECTIVE: To describe the prevalence of dental fluorosis, to investigate its association with individual and contextual variables among 12-year-old schoolchildren, and to determine whether there were changes in the prevalence of this condition from 2003 to 2010. METHODS: This cross-sectional study used data from an oral health survey carried out in Goiânia, Goiás, in 2010 (n = 2,075), and secondary data from the files of the local health authority. Clinical data were collected through oral examinations in public and private schools. The dependent variable was the presence of dental fluorosis, assessed using the Dean Index. The independent individual variables were sociodemographic characteristics (the child's gender and race, and the mother's level of schooling) and those related to clinical conditions (caries experience, evaluated using Decayed, Missing, and Filled teeth index; and presence of periodontal calculus and/or bleeding, evaluated using Community Periodontal Index). The contextual variables were linked to the school (type and existence of toothbrushing program) and its geographic location in the city's health districts. The Rao-Scott test was performed, and the percentage difference between the prevalences in the period from 2003 to 2010 was calculated. RESULTS: The prevalence of dental fluorosis in 2010 was 18.7%, being distributed as very mild (11.2%), mild (4.4%), moderate (2.6%), and severe (0.5%). No significant association was found between prevalence of dental fluorosis and the investigated variables. The prevalence of fluorosis increased 230% from 2003 to 2010, and such difference was significant. CONCLUSIONS: The prevalence of dental fluorosis was low, predominantly of the very mild degree, has increased over a 7-year period, and was not associated with the individual or contextual factors studied.

Individual and contextual determinants of malocclusion in 12-year-old schoolchildren in a Brazilian city.

The aim of this study was to describe malocclusion prevalence and its association with individual and contextual factors among Brazilian 12-year-old schoolchildren. This cross-sectional study included data from an oral health survey carried out in Goiânia, Brazil (n = 2,075), and data from the files of the local health authority. The data were collected through oral clinical examinations. The Dental Aesthetic Index (DAI) was used to assess occlusion. The presence of malocclusion (DAI > 25) was used as the dependent variable. The individual independent variables consisted of adolescents' sex and race and their mothers' level of schooling. The clinical variables were caries experience and presence of adverse periodontal condition (calculus and/or gingival bleeding). The contextual variables included type of school and the location of schools in the city's health districts. The Rao-Scott test and multilevel logistic regression were performed. The prevalence of malocclusion was 40.1%. In the final model, significantly higher rates of malocclusion were found among those who attended schools located in less affluent health districts and whose mothers had fewer years of education. Rates were also higher among those presenting calculus and/or gingival bleeding. Malocclusion demonstrated a high prevalence rate and the inequalities in its distribution were determined by individual and contextual factors.

Contextual and individual determinants of dental pain in preschool children.

OBJECTIVES: Despite growing interest on dental pain in children, there are very few studies on its prevalence and determinants among preschool children. The objective of this study was to assess prevalence of dental pain and associated individual and contextual factors in 5 year-old Brazilian children. METHODS: This cross-sectional study used primary data from the 2010 National Survey of Oral Health, carried out in capital cities and a sample of country towns. Participants were 7280 5-year-olds, who were examined in their homes and whose parents answered a questionnaire. Dependent variable was report of dental pain in the last 6 months. Independent variables were contextual (city level) socioeconomic factors, and individual (child) sociodemographic and oral health-related variables. Data analysis included hierarchized Poisson regression models, using a multilevel approach and prevalence rate (PR) estimates. RESULTS: The prevalence of dental pain was 22.0% (95% CI 19.1-25.2). It was higher among those living in cities with lower human development index (PR 0.07; 95% CI 0.02-0.22) and with a higher percentage of their population with an incomplete primary education (PR 1.03; 95% CI 1.01-1.06). Indigenous children had prevalence of dental pain 1.97 times higher (95% CI 1.19-3.26) than those of white colour. Families with monthly incomes of U$ 218.00 or less and between U$ 219.00 and U$ 656.00 had, respectively, a prevalence of dental pain 2.67 (95% CI 1.33-5.32) and 2.11 (95% CI 1.03-4.32) times higher than families with highest income level. For each unit increase in the number of dwellers per bedroom, there was a 14% increase in the probability of having pain. Children with caries experience had a 3.45 (95% CI 2.58-4.62) higher prevalence of pain than caries-free individuals. CONCLUSION: Dental pain prevalence in Brazilian preschool children was high and influenced by contextual and individual factors.

Dental caries in 12-year-old schoolchildren: multilevel analysis of individual and school environment factors in Goiânia.

The aim of this study was to investigate the association between dental caries index among 12-year-old schoolchildren and individual and contextual factors related to the schools in the city of Goiânia, Goiás, Brazil. A cross-sectional study was carried out with 2,075 schoolchildren using the 2010 National Survey of Oral Health methodology. The dependent variable was the decayed, missing, and filled teeth (DMFT) index and the independent variables were individual (sex, race, and maternal education) and contextual ones (type of school, health district, and the presence of oral programs). Multilevel analysis and log-linear negative binominal regression were performed, considering the complex sampling design. Mean DMFT index was 1.51. Female students, whose mothers had lower schooling, those attending public schools, located in districts with the worst socioeconomic indicators, and covered by the Family Health Strategy had higher caries levels. The dental caries index was low and associated with the schoolchildren sociodemographic characteristics and factors related to the schools, showing inequalities in distribution.

Factors associated with the need for a complete denture in one arch or both arches among the elderly population

Abstract: This study aimed to identify factors associated with the need for complete dentures in one dental arch or both, among the elderly population. The cross-sectional household study was conducted with a representative sample of elderly people (65 years or older) in the state of São Paulo, Brazil, in 2015. The dependent variable was the need for complete dentures (in one arch or both), and independent variables were socioeconomic and demographic conditions, social capital, self-perception of oral health and access to dental services. Simple and multinomial logistic regression models tested effect measures (p < 0.05). A total of 5,948 elderly people participated. Results indicated that those with greater chances of needing a complete denture in one arch were male (OR = 1.54; CI95%:1.04-2.29), with fewer household goods (OR = 2.25; CI95%:1.50-3.38), lower monthly household income: R$501-1500 (OR = 3.44; CI95%:1.27-9.35), R$1501-2500 (OR = 4.11; CI95%:1.50-11.27), R$2501-4500 (OR = 2.76; CI95%:1.10-6.95), self-reported need for a complete denture (OR = 4.75; CI95%:3.08-7.35), ≥3 years since last dental appointment (OR = 1.80; CI95%:1.06-3.05), and dissatisfaction with last dental appointment (OR = 1.80; CI95%:1.06-3.05). There were more chances of the need for complete dentures in both arches among older elders (OR = 1.44; CI95%:1.06-1.88), with lower monthly household income: R$ < 501 (OR = 4.45; CI95%:1.71-11.60), R$501-1500 (OR = 4.01; CI95%:2.14-7.51), R$1501-2500 (OR = 2.95; CI95%:1.64-5.32), < 3 years of education (OR = 1.45; CI95%:1.13-1.85), feeling unhappy (OR = 2.74; CI95%:1.35-5.57), self-reported need for a complete denture (OR = 8.48; CI95%:5.75-12.50), dissatisfaction with their mouth (OR = 2.38; CI95%:1.64-3.46), ≥3 years since last dental appointment (OR = 4.28; CI95%:2.85-6.43), and dissatisfaction with last dental appointment (OR = 4.28; CI95%:2.85-6.43). The several dimensions of the determinants of the need for a complete denture reflect the influence of both demographic and socioeconomic aspects, social capital, self-perception of oral health and access to dental services.

Oral health status of the ethnic group Xukuru from Ororubá: multilevel analysis.

OBJECTIVE: To analyse the oral health status of the indigenous people Xukuru from Ororubá aged 10 to 14 years old, in Pernambuco, Brazil. METHOD: A cross-sectional population-based study developed within the limits of the Indigenous Land Xukuru, from January to March 2010. Oral examinations were performed on a sample of 233 indigenous people. The software SPSS 13.0® was used for descriptive analysis. Later, in order to measure the effect of factors associated with the absence of caries, Poisson log-linear multilevel models were tested with the statistical software MLwiN 2.02®. RESULTS: Oral examinations identified a DMFT Index average of 2.38 (± 2.62). Among all individuals examined, 26.61% were caries free. Multiple regression analysis revealed a negative association between the absence of caries and the variables: higher average of people per household in the villages, higher number of residents per household, older age, male sex, not knowing how to read and write, and very dissatisfied/dissatisfied with teeth/mouth. The variables higher income per capita, not sleeping due to dental problems, had never been to the dentist, no occurrence of toothache, and no need for dental treatment were positively associated with the absence of caries. CONCLUSION: The absence of caries is associated with contextual and individual factors of the indigenous people Xukuru from Ororubá, aged 10 to 14 years old.

Avaliação da qualidade da assistência em saúde bucal na Atenção Primária à Saúde em Pernambuco, 2014 / Evaluación de la calidad de la asistencia en salud bucodental en la Atención Primaria a la Salud en Pernambuco, Brasil, 2014 / Evaluation of the quality of oral health care in Primary Health Care in Pernambuco, Brazil, 2014

Objetivo: avaliar a qualidade da assistência em saúde bucal na Atenção Primária à Saúde em Pernambuco, Brasil, 2014. Métodos: estudo ecológico de avaliação em saúde, baseado no modelo Donabediano, com dados secundários do 2º ciclo do Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB); a comparação entre as variáveis de estrutura, processo e resultado foi realizada pelo teste de Kruskal-Wallis; aquelas que apresentaram significância estatística (p<0,05) foram retratadas em mapas temáticos e de dependência espacial. Resultados: o padrão de qualidade dos municípios para a dimensão 'Estrutura' foi melhor pontuado que para a dimensão 'Processo de trabalho'; identificaram-se correlações entre os indicadores de urgência odontológica, cobertura de escovação dental supervisionada e tratamentos concluídos, nos estratos de qualidade relacionados ao processo de trabalho das equipes de Saúde Bucal. Conclusão: a organização do processo de trabalho mostrou ser fator determinante no impacto sobre alguns indicadores de uso de serviços.

Objetivo: evaluar la calidad de asistencia en salud bucodental en Atención Primaria a la Salud, Pernambuco, Brasil, 2014. Métodos: estudio ecológico de evaluación en salud, basado en modelo Donabediano, con datos secundarios del 2º ciclo del Programa Nacional de Mejora del Acceso y Calidad de la Atención Primaria a la Salud (PMAQ-AB); se compararon las variables de estructura, proceso y resultado por medio de la prueba de Kruskal-Wallis; las que presentaron significado estadístico (p<0,05) fueron retratadas en mapas temáticos y de dependencia espacial. Resultados: el patrón de calidad de los municipios para dimensión de la `Estructura´ fue mejor puntuado que la dimensión `Proceso de trabajo´; se identificaron correlaciones entre los indicadores de urgencia odontológica, cobertura de cepillado dental supervisado y tratamientos concluidos, en los estratos de calidad relacionados a los procesos de trabajo de los equipos de Salud Bucodental. Conclusión: la organización del proceso de trabajo mostró ser factor determinante en el impacto sobre algunos indicadores de uso de servicios.

Objective: to evaluate the quality of oral health care in Primary Health Care services in Pernambuco state, Brazil, 2014. Methods: this was an ecological health evaluation study based on the Donabedian model, involving secondary data from the 2nd cycle of the National Program for Improving Access and Quality of Primary Health Care (PMAQ-AB); comparison between the structure, process and outcome variables was done using the Kruskal-Wallis test (p<0.050); variables showing statistical significance (p<0.05) were portrayed through thematic and spatial dependence maps. Results: the standard of quality in the municipalities for the 'Structure' dimension gained better scores than the 'Work process' dimension; correlations were identified between the indicators for dental urgency, supervised tooth brushing coverage and treatments completed, in quality strata related to the work process of the Oral Health teams. Conclusion: organization of the work process was seen to be a determining factor in the impact on some indicators of service use.