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

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

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

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

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

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

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

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

Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel.

BACKGROUND: To prevent child maltreatment, the identification of vulnerable children is essential. In Norway, public dental health personnel (PDHP) report suspicion of child maltreatment to child welfare services (CWS) at a relatively high rate. However, their reasons for reporting and the response from CWS have not been investigated. The objectives of this study were to (1) explore the reasons that PDHP send reports of concern, (2) examine how CWS responds to PDHP reports, and (3) assess whether different reasons for concern are associated with a given response from CWS. METHODS: A national cross-sectional study was conducted by an electronic survey distributed to public dental hygienists and dentists in Norway. Descriptive statistics were calculated in terms of mean (SD) distributions and frequency, expressed as % (n). To account for clustering of responses among respondents, binomial generalized estimating equation analysis was used to estimate odds ratios (ORs) and confidence intervals (CIs) of CWS responses across number of reports with different reasons for concern. RESULTS: Of a total of 1542 questionnaire recipients, 1200 (77.8%) responded to the survey. From 2012 to 2014, 42.5% of the respondents sent 1214 reports to CWS, with a mean number of 2.7 (SD = 2.0) reports per respondent. The PDHP sent the reports due to suspicion of neglect or physical, sexual and/or psychological abuse. Non-attendance at dental appointments and grave caries were reported most frequently. Among the reports, 24.5% resulted in measures being taken by CWS, 20.7% were dropped, and 29.4% lacked information from CWS on the outcome. Reports due to suspicion of sexual abuse, (OR 1.979, 95% CI (1.047-3.742), P = 0.036), grave caries (OR 1.628, 95% CI (1.148-2.309), P = 0.006), and suspicion of neglect (OR 1.649, 95% CI (1.190-2.285), P = 0.003) had the highest association with the implementation of measures. CONCLUSIONS: PDHP report on several forms of child maltreatment and contributes in detection of victimized children. However, the relatively low number of measures being taken by CWS and the number of reports that lack a response to reporters reveal a need for a closer cooperation between the services, as this would benefit both the children at risk and the services.

Internet use, online information seeking and knowledge among third molar patients attending public dental services.

BACKGROUND: While Australians are searching the internet for third molar (TM) information, the usefulness of online sources may be questioned due to quality variation. This study explored: (i) internet use, online information-seeking behaviour among TM patients attending public dental services; and (ii) whether patients' TM knowledge scores are associated with the level of internet use and eHealth Literacy Scale (eHEALS) scores. METHODS: Baseline survey data from the 'Engaging Patients in Decision-Making' study were used. Variables included: sociodemographics, internet access status, online information-seeking behaviour, eHEALS, the Control Preferences Scale (CPS) and TM knowledge. RESULTS: Participants (N = 165) were mainly female (73.8%), aged 19-25 years (42.4%) and had 'secondary school or less' education (58.4%). A majority (N = 79, 52.7%) had sought online dental information which was associated with active decisional control preference (odds ratio = 3.1, P = 0.034) and higher educational attainment (odds ratio = 2.7, P = 0.040). TM knowledge scores were not associated with either the level of internet use (F(2,152) = 2.1, P = 0.094, χ2 = 0.0310) or the eHEALS scores (r = 0.147, P = 0.335). CONCLUSIONS: 'The internet-prepared patient' phenomena exists among public TM patients and was explained by preference for involvement in decision-making. However, internet use was not associated with better TM knowledge. Providing TM patients with internet guidance may be an opportunity to improve TM knowledge.

Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey.

OBJECTIVE: Detecting and responding to child-maltreatment is a serious challenge and public health concern. In Norway, public dental health personnel (PDHP) have a mandatory obligation to report to child welfare services (CWS) if they suspect child-maltreatment. This study aimed to assess PDHP's frequency of reporting and failing to report to CWS and whether the frequencies varied according to personal, organizational and external characteristics. MATERIAL AND METHODS: An electronic questionnaire was sent to 1542 public dental hygienists and dentists in Norway, 1200 of who responded (77.8%). RESULTS: The majority 60.0%, reported having sent reports of concern to CWS throughout their career, 32.6% had suspected child-maltreatment but failed to report it in their career and 42.5% had sent reports during the three-year period from 2012 to 2014. The reporting frequency to CWS was influenced by PDHP's personal, organizational and external characteristics, while failure to report was influenced by personal characteristics. CONCLUSIONS: Compared to international studies, PDHP in Norway sends reports of concern and fails to report to CWS at relatively high rates. PDHP's likelihood of reporting was influenced by age, working experience, number of patients treated, size of the municipality and geographical region, while failure to report to CWS was influenced by working experience.

Half-century of Dental Public Health research: bibliometric analysis of world scientific trends.

OBJECTIVES: To describe the characteristics of Dental Public Health (DPH) scientific publications within core DPH journals over time and to compare DPH journals with DPH content from other journal types. METHODS: The Scopus database was used to identify DPH-relevant articles published from 1965 to 2014 in three core DPH journals (DPHJs) and from 2005 to 2014 in Dental Journals (DJs), Public Health (PHJs) and General Journals (GJs). To identify DPH-relevant articles, a search strategy with words about oral health and public health was applied to each group of journals. Research themes were created by grouping similar keywords to report changes in the focus of articles over time. The most productive journals, countries, institutions and authors were also estimated for each set of journals. RESULTS: In 2005-2014, 60 297 articles were identified, of which 2.7% in DPHJs, 10.4% from PHJs, 38.2% from GJs and 48.7% from DJs. DPH-relevant articles published in the core DPHJs, DJs and PHJs tended to share a strong emphasis on dental caries, healthcare/services research on children and adolescents. Over time, the focus in the DPHJs has increased towards health behaviour/promotion/education, quality of life and socioeconomic factors. In the last decade, those themes were more frequent in DPH journals than in the other groups. CONCLUSIONS: DPH research published in DPHJs had some unique features and greater focus on the themes of quality of life, socioeconomic factors and health behaviour/education/promotion than other groups of journals.

[Reimbursement of public dental care in Germany, the United Kingdom, Hungary and Poland]. / A fogászati ellátás finanszírozása Németországban, az Egyesült Királyságban, Magyarországon és Lengyelországban.

INTRODUCTION: Dental treatments have the highest rate among medical interventions and their reimbursement is also significant. AIM: The aim of the study was to compare the outcome of the reformed healthcare system process on public dental services in four European countries. METHOD: Assessment base for the comparison of reimbursement of dental treatments and dental fee schedules provided by the health insurance funds were used. The following indicators were examined: the ratio of public dental services and the main oral health indicators. Among dental fee schedules, reimbursement of general dental activity, prevention, operative dentistry, endodontic and oral surgery were selected. RESULTS: The lowest value of population to active dentist ratio was found in Germany (population to active dentist ratio: 1247) and the highest in Hungary (population to active dentist ratio: 2020). Oral health indicators showed significant differences between the West-European and East-European countries. On the other hand, the ratio of completely edentulous people at the age of 65yrs did not show great variations. Reimbursement of public dental treatments indicated significantly higher value in Germany and the United Kingdom compared to the other countries. CONCLUSIONS: Reimbursement of public dental services varies considerably in the selected European countries.

Dental public health capacity worldwide: Results of a global survey.

The World Federation of Public Health Associations' Oral Health Working Group (WFPHA OHWG) carried out a survey to establish the extent of global dental public health (DPH) capacity. Senior stakeholders in DPH completed 124 surveys, covering 73 countries and all WHO regions. The survey evaluated DPH workforce within the country, funding, education, current services, and integration between public health and DPH in countries across the world. In 62 per cent of countries, DPH is only partially integrated in the public health system, while in 25 per cent of countries it has not yet been formally integrated. DPH programs at Masters level are available in 44 per cent of countries. Over half of countries have 0 to 10 trained DPH professionals. Because both poor oral and general health share several common risk factors, DPH must be integrated into national health systems and budgets, with an emphasis on having trained DPH specialists available in every country to collaborate in healthcare policy and provision.

The oral health of seniors in Brazil: addressing the consequences of a historic lack of public health dentistry in an unequal society.

OBJECTIVE: National epidemiological data on the oral health of elders was analysed to examine relationships between the need for oral treatment and external environment, the dental care delivery system, personal characteristics and subjective conditions of oral health. BACKGROUND: Brazil's universal public healthcare system is theoretically responsible to provide dental care to Brazilians of all ages. However, as dentists were integrated into public primary care facilities only in 2000, Brazilian seniors have accumulated needs. MATERIALS AND METHODS: Seniors (65-74 years old) were examined and interviewed by calibrated professionals. The association of overall need for oral treatment and component factors were analysed. Associations with socio-demographic factors and self-reported attitudes and behaviours were also calculated. RESULTS: A total of 85.9% of Brazilian seniors demonstrated a need for some oral treatment, 83.8% of the dentate needed periodontal treatment and 57.3% of all seniors needed full or partial prostheses. Social inequalities were also evident as Brazilians using free oral care services demonstrated a higher degree of need, as did elders who had not previously accessed dental services, nonwhites and males. CONCLUSIONS: Our findings demonstrate that the elderly population in Brazil has a very high degree of need in general and that certain subgroups have been especially vulnerable to oral disease.

Evolução da cobertura das equipes de saúde bucal nas macrorregiões brasileiras / Expansion of the oral health family teams among the Brazilian regions

A saúde bucal no Brasil impulsionou-se com a implantação das Equipes de Saúde Bucal (ESB), Estratégia Saúde da Família (ESF). Este artigo propôs-se analisar a evolução da cobertura das ESB, nas macrorregiões brasileiras. Os dados foram obtidos do consolidado histórico de cobertura da saúde da família, Departamento da Atenção Básica/Ministério da Saúde (2001- 2013) e analisados no programa STATA®10.0. Observou-se que a 59,2% da quantidade de ESB I em relação ao total de equipes brasileiras implantadas no ano de 2001 estava na região Nordeste e 4,9% no Norte, em 2013: 48,5% e 7,8%, respectivamente. Quanto à proporção populacional coberta por algum tipo de ESB o Nordeste apresentou maior proporção de ESB I: 69,1% e Sudeste, menor proporção 25,6%. Ao relacionar-se a proporção ESB I/ESB II o Nordeste apresentou a pior relação 1:33,4 e o Sul melhor 1:5,6. Na análise de regressão de efeitos mistos houve associação significante entre número ESB e teto de implantação de equipes. Concluiu-se então que o número de ESB é insatisfatório, cobrindo apenas 42,1% da população brasileira, bem aquém do teto de 100%. Desde sua implantação, as ESB I apresentaram crescimento exponencial, enquanto as ESB II apresentaram um crescimento discreto.

Oral health care in Brazil boosted with the implementation of oral health teams (ESB), the Family Health Strategy (FHS). This paper set out to analyze the evolution of the coverage of ESBs in the Brazilian regions. Data were obtained from the historical consolidated coverage family health, Department of Primary Care / Ministry of Health (2001- 2013) and analyzed in STATA®10.0 program. Through them we observed, distribution of ESB I in 2001: 59.2% - 4.9% -North and Northeast in 2013: 48.5% and 7.8%, respectively. As for the population proportion covered by any kind of ESB, northwest showed a higher proportion of ESB I: 69,1% and Southeast smaller proportion 25,6%. In relating the proportion ESB I / II ESB: 1: 33,4 Northwest- wost and better South: 1: 5,6. In the analysis of mixed effects regression was no significant association between the average number ESB and cover needs. It was concluded that the number of ESB is unsatisfactory, covering only 42,1% of the population, totally apart from the ceiling of 100%. Since its implementation, the ESB I showed exponential growth, while the ESB II showed a slight growth.

Preventive and clinical care provided to adolescents attending public oral health services New South Wales, Australia: a retrospective study.

BACKGROUND: Dental Therapists and Oral Health Therapists (Therapists) working in the New South Wales (NSW) Public Oral Health Service are charged with providing clinical dental treatment including preventive care for all children under 18 years of age. Adolescents in particular are at risk of dental caries and periodontal disease which may be controlled through health education and clinical preventive interventions. However, there is a dearth of evidence about the type or the proportion of clinical time allocated to preventive care.The aim of this study is to record the proportion and type of preventive care and clinical treatment activities provided by Therapists to adolescents accessing the NSW Public Oral Health Service. METHODS: Clinical dental activity data for adolescents was obtained from the NSW Health electronic Information System for Oral Health (ISOH) for the year 2011. Clinical activities of Therapists were examined in relation to the provision of different types of preventive care for adolescents by interrogating state-wide public oral health data stored on ISOH. RESULTS: Therapists were responsible for 79.7 percent of the preventive care and 83.0 percent of the restorative treatment offered to adolescents accessing Public Oral Health Services over the one year period. Preventive care provided by Therapists for adolescents varied across Local Health Districts ranging from 32.0 percent to 55.8 percent of their clinical activity. CONCLUSIONS: Therapists provided the majority of clinical care to adolescents accessing NSW Public Oral Health Services. The proportion of time spent undertaking prevention varied widely between Local Health Districts. The reasons for this variation require further investigation.

An assessment of career satisfaction among Macedonian dentists.

AIM: The aim of this study was to assess the level of overall career satisfaction in relation to various personal and work-related factors among the dentists in the Republic of Macedonia. MATERIALS AND METHODS: The sample comprised 118 registered dentists, working in different conditions (34 public practice dentists, 32 completely private, 42 private dentists who work with a health insurance fund and 10 concessioners). All of them filled in a questionnaire which contained 16 items, divided into five groups. The different clusters of questions were related to various working conditions and personal factors. The first four groups of questions were answered with a--point Likert format with a score range from 1 (very dissatisfied) to 4 (very satisfied). In the fifth group, dentists chose one of four offered answers. The statistical analyses were made by one-way ANOVA and chi-square tests. RESULTS: Significant differences related to working conditions were found between public practitioners (moderately dissatisfied) and private practitioners (very satisfied) (F=41.41 (df=3); p<0.01). A high prevalence of dentists (89.83%) had felt stressed on their work place and 61.8% of public dental health practitioners had felt stressed at work "very often". The main sources of job-related stress for public dental practitioners were their supervisors (50%) and patients (26. 47%), while private practitioners were mostly stressed by inspectors (76.19%) and patients (21.87%) (χ2=44.5 (df=9); p<0.01). CONCLUSION: The findings in our study showed overall low levels of career satisfaction among the dentists (public and private) in the Republic of Macedonia. The finding that high percentages of dentists feel stress at their work place very often requires further exploration.

Adverse events in Public Dental Service in a Swedish county--a survey of reported cases over two years.

Adverse events cause suffering and increased costs in health care. The main way of registering adverse event is through dental personnel's reports, but reports from patients can also contribute to the knowledge of such occurrences. This study aimed to analyse the adverse events reported by dental personnel and patients in public dental service (PDS) in a Swedish county. The PDS has an electronic system for reporting and processing adverse events and, in addition, patients can report shortcomings, as regards to reception and treatment, to a patient committee or to an insurance company. The study material consisted of all adverse events reported in 2010 and 2011, including 273 events reported by dental personnel, 53 events reported by patients to the insurance company and 53 events reported by patients to the patient committee. Data concerning patients' age and gender, the nature, severity and cause of the event and the dental personnel's age gender and profession were collected and analysed. Furthermore the records describing the dental personnel's reports from 2011 were studied to investigate if the event had been documented and the patient informed. Age groups 0 to 9 and 20 to 39 years were underrepresented while those between the ages 10 to 19 and 60 to 69 years were overrepresented in dental personnel's reports. Among young patients delayed diagnosis and therapy dominated and among patients over 20 years the most frequent reports dealt with inadequate treatments, especially endodontic treatments. In 29% of the events there was no documentation of the adverse event in the records and 49% of cases had no report about patient information. The majority of the reports from dental personnel were made by dentists (69%). Reporting adverse events can be seen as a reactive way of working with patient safety, but knowledge about frequencies and causes of incidents is the basis of proactive patient safety work.

Rubber dam use during root canal treatment: findings from The Dental Practice-Based Research Network.

BACKGROUND: The Dental Practice-Based Research Network (DPBRN) provided a means to investigate whether certain procedures were performed routinely. The authors conducted a study to quantify rubber dam use during root canal treatment (RCT) among general dentists and to test the hypothesis that certain dentist or practice characteristics were associated with rubber dam use. METHODS: DPBRN practitioner-investigators (P-Is) answered a questionnaire that included items about rubber dam use and other forms of isolation during RCT. DPBRN enrollment questionnaire data provided information regarding practitioner and practice characteristics. RESULTS: A total of 729 (74 percent) of 991 P-Is responded; 524 were general dentists who reported providing at least some RCTs and reported the percentage of RCTs for which they used a rubber dam. Of these 524 P-Is, 44 percent used a rubber dam for all RCTs, 24 percent used it for 51 to 99 percent of RCTs, 17 percent used it for 1 to 50 percent of RCTs, and 15 percent never used it during RCT. Usage varied significantly by geographic region and practice type. The use of cotton rolls and other forms of isolation also was reported. CONCLUSIONS: Similar to other reports in the literature, not all DPBRN general dentists used a rubber dam during RCT. CLINICAL IMPLICATIONS: Because the clinical reference standard is to use a rubber dam during RCT, increasing its use may be important.

Assessing the community clinic replacement effect on private Medicaid practices in oral health care within rural environments.

OBJECTIVES: Children in Medicaid/CHIP public coverage programs who reside in rural counties have limited access to dental care services. Shortages of dental professionals in rural areas impede utilization of dental care. Public and private initiatives are attempting to address this crisis. Missourians instituted deregulatory policies and invested in community-based initiatives. METHODS: Using a Medicaid/CHIP claims administrative dataset from 2004 to 2007, this research explored patterns of utilization to assess the impact of these efforts. RESULTS: The number of participating private dental office providers declined over the study period, and the number of children utilizing clinics increased. Trends are being observed within the public health dental care market demonstrating clinics are replacing private dentists as providers of Medicaid/CHIP dental services. CONCLUSIONS: Allowing greater market entry through deregulation could provide states with greater improvements to their public dental health infrastructure.

Condições de saúde bucal e fatores associados à perda dentária entre adultos de Montes Claros- MG / Oral health conditions and factors associated with tooth loss in adults in Montes Claros- MG

Introdução: Tem aumentado o interesse pela produção de informações epidemiológicas relativas à saúde bucal dos adultos, que constituem a maioria da população, demandam por serviços odontológicos, influenciam decisivamente o comportamento de deus dependentes, possuem problemas específicos de saúde bucal e particularidades epidemiológicas. A perda dentária constitui-se como um importante indicador de saúde bucal entre adultos. objetivos: i) descrever o perfil dos adultos do município de Montes Claros - MG segundo condições sociodemográficas, utilização dos serviços odontológicos, comportamentos e condições subjetivas relacionadas à saúde bucal; ii) descrever as condições normativas de saúde bucal desses adultos; iii) estimar a prevalência de perdas dentárias por cárie entre os adultos e testar a associação entre tais perdas e variáveis relativas ao acesso a informações em saúde bucal; iv) avaliar o impacto da correção pelo efeito de desnho nas estimativas decorrentes de amostragem por conglomerados em estudo epidemiológico sobre condições de saúde bucal de adultos...

The burden of early childhood caries in the Western Cape Public Service in relation to dental general anaesthesia: implications for prevention.

INTRODUCTION: Multiple extractions under Dental General Anaesthesia (DGA) are frequently performed on pre-school children treated in the public sector in the Western Cape. There s a need to examine current public health strategies in relation to Early Childhood Caries (ECC) in order to provide a framework for both the improvement of treatment and the prevention of ECC in general. METHODS: This retrospective descriptive study reviewed the records on the Department of Health (DoH) database of 16 732 pre-school patients treated under Dental General Anaesthesia over a three year period. RESULTS: Of the 58 255 procedures recorded for these preschool patients in the district health clinics in the Western Cape, 99.94% were for extractions and 0.0001 for restorations. The average rate of DGA per 1000 of the population was 1.06. Only 9% (i.e.: 2/22) of dentists at district clinics reported that pre-DGA prevention was provided. CONCLUSION: The demand for DGA was found in this study to be relatively high and the associated treatment was almost exclusively by means of extractions. The lack of preventive measures could possibly result in a need for retreatment under DGA. Therefore, preventive guidelines are recommended for use in the Public Service.

Accuracy and reproducibility of dental caries risk classification in São Paulo, Brazil / Acurácia e reprodutibilidade da classificação de risco de cárie dentária em São Paulo, Brasil

Aim: To evaluate the accuracy and reproducibility of the dental caries risk classification applied in the state of São Paulo, Brazil, in an attempt to organize the demand for primary care in oral health. Materials and Methods: Eleven dentists independently examined 120 individuals (75 from 12 to 19 years of age and 45 from 35 to 44 years of age) by visual inspection, and classified them into six codes ranging from A to F, in which code A indicated the healthiest individual (low-risk) and F indicated the sickest individual (high-risk). Theagreement between the intraexaminer and the gold standard examiner was evaluated by Kappa. The percentageof agreement, sensitivity, specificity, positive predictive value, and negative predictive value regarding the goldstandard examiner was also calculated. Results: It could be observed that 60.0% of the individuals examinedwere considered sick, while 40.0% were considered healthy. Values for intra and inter-examiner agreementwere k=0.66 and k=0.72, respectively. The percentage of agreement, sensitivity, specificity, positive predictivevalue, and negative predictive values were 83.8%, 82.5%, 85.8%, 90.2%, and 76.9%, respectively. Conclusion:This study suggests that the dental caries risk classification, with its various levels of standardization, presentedgood accuracy and reasonable reproducibility, as well as a low cost a and a relatively low demand for resources. As such, this risk classification is recommended for large-scale use.

Urgências odontológicas em uma Unidade de Saúde vinculada à Estratégia Saúde da Família de Montes Claros, Minas Gerais / Emergency dental services in a Health Unit linked to the Family Healthcare Strategy of Montes Claros, Minas Gerais

Objetivo: Identificar os casos de urgência odontológica na Estratégia Saúde Família, em Montes Claros, Minas Gerais caracterizando o usuário pelo perfil sociodemográfico, de comportamento em saúde,estilo de vida e condição sistêmica. Materiais e Métodos: Trata-se de estudo transversal e quantitativo, de base documental. Foram avaliados 164 prontuários odontológicos, de adultos e idosos, atendidos entre 2008 e 2010. A análise dos dados foi por meio do teste χ2 de Pearson e pelo teste t de Student considerando o nível de significância p<0,05. Resultados: A idade média dos usuários foi de 35,0 anos (±12,9), sem diferença estatística entre os sexos (p=0,06). As mulheres (63,4%) e os alfabetizados (97,6%) utilizaram mais o serviço de urgência. A presença de alguma doença sistêmica foi registrada em 22,6% dos documentos. A média de escovação dental diária foi de 2,73 (±8,15), com diferença significativa para etilismo e sexo (p<0,05). A maioria dos homens e das mulheres não faz uso de fio dental (p=0,15). Cerca de 37,0% dos pacientes concluíram o tratamento, não sendo associada à condição sistêmica, ao tabagismo e ao etilismo (p>0,05). A dor foi a principal queixa que motivou a procura pelo serviço, sendo a cárie o diagnóstico mais frequente. Conclusão: A maioria das pessoas que procurou pelo serviço de urgência odontológica é do sexo feminino e possui idade média de 35 anos. A cárie foi o problema mais constatado, sendo a procura pelo serviço motivada, principalmente, pela dor.