Analysis of hospital dental care for patients with special needs in Brazil.

This analytical cross-sectional study aimed to analyze the access of patients with special needs (PSN) in Brazilian municipalities to hospital dental care of the Unified Health System (Sistema Único de Saúde - SUS), based on data from the Hospital Information System of the Unified Health System (Sistema de Informações Hospitalares do SUS- SIH/SUS - SIH), from 2010 to 2018. The Kolmogorov-Smirnov normality test was performed; the Poisson regression was used to verify factors associated with the variable total number of hospitalization authorizations with the main procedure of dental treatment for PSN ("Total de Autorizações de Internação Hospitalar" - AIH), the Spearman correlation test with a significance level of 5% was used to characterize the relationships between the Municipal Human Development Index per municipality - (Índice de Desenvolvimento Humano Municipal - HDI) and the Oral Health Coverage in the Family Health Strategy by municipality (Cobertura de saúde bucal na estratégia saúde da família por município - SBSF Coverage), and the relationship of the AIH with SBSF Coverage. A total of 127,691 procedures were performed, of which 71,517 (56%) were clinical procedures, such as restorations, endodontic treatments, supra and subgingival scaling, among others. Municipalities in the Midwest (PR=5.117) and Southeast (RP = 4.443) regions had more precedures than the others. A weak correlation was found between AIH and SBSF Coverage (r = -0.2, p < 0.001) and HDI and SBSF Coverage (r = -0.074, p < 0.001). Population size, region, health coverage, oral hygiene, and number of dentists in hospitals affected the availability of dental procedures in PSN.

Territorial Disparities in Dental Care for Disabled Persons and Oral Health-Related Indicators: A Population-Level Approach in Brazil's Public Healthcare System from 2014 to 2023.

This study evaluated territorial disparities in dental care for disabled persons in Brazil's public healthcare system from 2014 to 2023. The person-year incidence of outpatient dental procedures carried out by special care dentistry specialists and hospitalizations for dental procedures for disabled persons were compared across different regions and against the national estimate. In addition, productivity was correlated with oral health-related indicators. The significance level was set at 5%. The northern region exhibited the highest outpatient productivity, while the southern region showed lower productivity compared to the national estimate (both p-value < 0.05). This pattern was reversed in inpatient productivity (both p-value < 0.05), with the northeastern and central-western regions also below average (both p-value < 0.05). There were no significant correlations between the indicators and inpatient productivity, but outpatient productivity was positively correlated with the proportions of inhabitants who self-rated their general and oral health as "poor" or "very poor", who have never visited a dentist, and who visited a dentist for tooth extraction (all p-values < 0.05). Territorial disparities in dental care for disabled persons were observed within Brazil's public healthcare system, and they were correlated with unfavorable oral health-related indicators at the population level.

Covid-19 y la odontología latinoamericana para pacientes con necesidades especiales / Covid-19 and latin american dentistry for patients with special needs / Covid-19 and dental care for patients with special needs in Latin America

Resumen La región de América Latina se ha convertido en la más afectada del mundo por la pandemia del COVID-19. Y personas con necesidades especiales, población ya vulnerable, están sufriendo un impacto significativo de la crisis actual. Dado que estas personas no pueden dejar de ser protegidas y cuidadas, un grupo de profesores de 10 países de América Latina se reunió para analizar la situación de la odontología para pacientes con necesidades especiales en la región. En todos los países, se evidenció que el confinamiento y las restricciones de desplazamiento están interrumpiendo el acceso a bienes y servicios esenciales para ellos. En cuanto a la odontología, la disposición general es posponer los procedimientos de rutina, a menos que sean clínicamente urgentes o de emergencia; adoptar estrictas medidas de protección personal y evitar o minimizar las intervenciones que puedan producir aerosoles. La atención odontológica remota, teleodontología, se considera como una herramienta fundamental en este momento, ya que permite evaluar la necesidad de atención presencial y ofrecer soporte, información y seguridad a los pacientes y familias. La pandemia nos ha demostrado, a todos, que impulsar la Promoción de la Salud es el verdadero camino, y que no debemos esperar a que se presenten condiciones que afecten la calidad de vida.

Resumo: A região da América Latina tem se tornado a mais afetada do mundo pela pandemia do COVID-19. E as pessoas com necessidades especiais, população já vulnerável, estão sofrendo um impacto significativo da crise atual. Uma vez que essas pessoas não podem deixar de ser protegidas e cuidadas, um grupo de professores de 10 países de América Latina se reuniu para analisar a situação da odontologia para pacientes com necessidades especiais na região. Em todos os países se verificaram que o confinamento e restrições de movimento estavam interrompendo o acesso a bens e serviços essenciais para eles. Para a odontologia, a orientação geral é adiar procedimentos de rotina, a menos que seja clinicamente urgente ou emergencial; adotar medidas rígidas de proteção individual e evitar ou minimizar intervenções que possam produzir aerossóis. O atendimento odontológico à distância, teleodontología, é considerada uma ferramenta fundamental neste momento, pois permite avaliar a necessidade de atendimento presencial e oferecer suporte, informação e segurança aos pacientes e famílias. A pandemia tem demostrado, para todos, que trabalhar na Promoção da Saúde é o verdadeiro caminho, e que não devemos esperar por condições que afetem a qualidade de vida.

Abstract Latin America has become the most affected region by the COVID-19 pandemic in the world. People with special needs-an already vulnerable population-are suffering terrible consequences on account of this crisis. These people need to be protected and cared for at all times. Therefore, a group of lecturers from ten Latin American countries came together to analyze the regional situation of dental care for patients with special needs. Every country shows evidence that lockdowns and movement restrictions interrupt these people's access to essential goods and services. The general course of action regarding dental care is to postpone routine procedures unless they are clinically urgent or an emergency, implement strict personal protection measures and avoid or minimize processes that may produce aerosols. Remote dental care is considered essential these days since it allows practitioners to assess the need for face-to-face care and offer support, information, and safety to patients and families. The pandemic has shown us all that supporting health promotion is the true path and that we should not wait until conditions that affect people's quality of life appear to act.

Avaliação do nível de percepção de cirurgiões-dentistas das redes pública e privada de um município do norte do Rio Grande do Sul sobre atenção em saúde a pacientes com necessidades especiais / Assessment dentists level of perception in public and private service of a city in the north of Rio Grande do Sul about health care for patients with special needs

Objetivo: identificar a percepção de cirurgiões-dentistas das redes pública e privada do município de Erechim, RS, sobre atenção em saúde a pacientes com necessidades especiais, avaliando conhecimento, preparo e limitações para o atendimento odontológico. Métodos: este estudo de caráter transversal ocorreu no período de março a agosto de 2019, por meio da aplicação de questionário próprio semiestruturado para cirurgiões-dentistas. Resultados: participaram da pesquisa 82 cirurgiões-dentistas, sendo a maioria (58,54%) atuantes na rede privada; 56,10% não cursaram uma disciplina específica em sua graduação sobre cuidados a pacientes com necessidades especiais. Em contrapartida, dos que cursaram, para a maioria, a disciplina era obrigatória e teórico-prática. Conclusão: apesar de somente 42,68% se sentirem muito bem ou bem preparados, somente 10,98% nunca realizaram atendimentos. Mesmo não tendo cursado uma disciplina específica em sua graduação, os cirurgiões-dentistas de Erechim, RS, realizam o atendimento e, quando necessário, o encaminhamento desses pacientes. Por manifestarem o interesse em se manterem atualizados sobre o tema, ações de educação continuada serão de fundamental importância.(AU)

Objective: assess dentists perception, about oral health care for patients with special needs, of public and private service of Erechim, RS, evaluating their knowledge, preparation and limitations for dental care. Methods: this cross-sectional research was conducted from March to August 2019, using questionnaires for dentists. Results: eighty-two dentists participated in the research, the majority (58.54%) are from the private service, 56.10% did not attend a specific discipline, in their graduation, about dental care for patients with special needs. In contrast, for those who attended, the discipline was compulsory and theoretical- -practical. Conclusion: although only 42.68% feel very well, or well prepared, only 10.98% never attended dental care. Even though they did not attend a specific discipline in their graduation, the dentists of Erechim, RS, perform dental care and, when necessary, they referral these patients. As they express their interest in keeping up to date on the topic, continuing education actions will be of fundamental importance.(AU)

Fatores de risco para a cárie dentária em pacientes com deficiências do desenvolvimento / Risk factors for dental caries in patients with developmental disabilities

O objetivo do presente estudo foi investigar fatores de risco para cárie dentária em crianças com deficiências de desenvolvimento que foram tratados em um serviço de referência para cientes com necessidades especiais, Belo Horizonte, MG, Brasil. Esta é uma coorte retrospectiva que avaliou 401 prontuários de indivíduos sem experiência de cárie dentária na primeira consulta odontológica. A variável dependente foi a ocorrência de uma nova lesão de cárie dentária ou restauração. O tempo para a ocorrência de uma nova lesão de cárie ou restauração foi medido em meses. Sexo, idade, Código Internacional de Doenças (CID), escolaridade da mãe, o consumo de açúcar, o uso de creme dental com flúor, higiene oral, respiração bucal, relato de xerostomia, condição gengival, uso de drogas psicotrópicas, utilização de medicamentos para a asma, história pregressa de asma foram as covariáveis estudadas. O modelo de regressão de Cox de riscos proporcionais foi utilizado para estimar as taxas de risco bruto e ajustado com seus respectivos intervalos de confiança de 95%. O tempo médio que os indivíduos permaneceram livres de cárie dental restauração foi igual a 107,46 meses (IC 95% 95,41-119,51), com mediana de 94 meses. Para cada aumento de um ponto na escala de consumo de sacarose, houve um aumento do risco de cáries em 1,07 (IC de 95% 1,01- 1,15). O consumo de sacarose foi o único fator de risco significativo para cárie neste grupo de indivíduos com deficiências do desenvolvimento

Access to dental public services by disabled persons.

BACKGROUND: According to the World Health Organization, one in every 10 people has a disability, and more than two-thirds of them do not receive any type of oral dental care. The Brazilian Constitution of 1988 guarantees all civilians including disabled people the right to healthcare, shaping the guidelines of the Brazilian National Health Care System (Sistema Único de Saúde--SUS). However, there is limited information about the true accessibility of dental services. This study evaluated the accessibility of public dental services to persons with disabilities in Fortaleza, Ceará, which has the third highest disability rate in Brazil. METHODS: A cross-sectional quantitative study using structured questionnaires was administered to dentists (n = 89) and people with disabilities (n = 204) to evaluate the geographical, architectural, and organizational accessibility of health facilities, the communication between professionals and patients with disabilities, the demand for dental services, and factors influencing the use of dental services by people with motor, visual, and hearing impairments. RESULTS: 43.1% of people with disabilities do not recognize their service as a priority of Basic Health Units (BHU), 52.5% do not usually seek dental care, and of those who do (n = 97), 76.3% find it difficult to receive care and 84.5% only seek care on an emergency basis. Forty-five percent are unaware of the services offered in the BHU. Of the dentists, 56.2% reported difficulty in communicating with deaf patients, and 97.8% desired interpreters stationed in the BHU. People with disabilities gave better accessibility ratings than dentists (p = 0.001). 37.3% of the patients and 43.8% of dentists reported inadequate physical access infrastructure (including doors, hallways, waiting rooms, and offices). Dentists (60%) reported unsafe environments and transportation difficulties as geographical barriers, while most people with disabilities did not report noticing these barriers. CONCLUSIONS: While access to dental services has increased in Fortaleza, the lack of accessibility of health units and their surroundings does not promote the treatment of people with disabilities. Cultural, organizational, architectural, geographical, and communication barriers constrain the demand for and use of oral dental care services by this social segment.

Saúde bucal de indivíduos brasileiros com mucopolissacaridose: um estudo transversal pareado / Oral health of brazilian individuals with Mucopolysaccharidosis: a paired crosssectional study

A mucopolissacaridose (MPS) é uma doença genética metabólica causada por erros inatos do metabolismo. Acarreta diversas alterações físicas, motoras e intelectuais. Dentre as alterações físicas, muitas estão presentes na face e na cavidade bucal. Na área odontológica ainda são poucos os estudos dedicados a MPS, sendo insuficientes as informações sobre as características dentárias presentes nas pessoas diagnosticadas com a doença. Este estudo objetivou comparar as características bucais de indivíduos brasileiros com MPS e sem MPS. O mesmo sera apresentado na forma de artigo científico. Foi realizado um estudo transversal, pareado, com 29 pacientes com MPS e 29 sem MPS, na faixa etária de 2 a 25 anos. A coleta de dados foi realizada em uma das clínicas da Faculdade de Odontologia da Universidade Federal de Minas Gerais (UFMG), na cidade de Belo Horizonte, região sudeste do Brasil. Foram convidados a participar do estudo todos os pacientes diagnosticados com MPS atendidos pelo Ambulatório de Erros Inatos do Metabolismo do Hospital das Clínicas da UFMG e pelo Hospital João Paulo II, bem como os respectivos pais/responsáveis. Os pacientes sem MPS foram selecionados nos Ambulatórios Bias Fortes (setor de pediatria) e São Vicente de Paula (setor de adolescentes). Aqueles pais/responsáveis que concordaram em participar do estudo responderam um questionário abordando aspectos individuais, socioeconômicos e comportamentais relacionados aos filhos. Foi realizado o exame da cavidade bucal dos pacientes com MPS e sem MPS. Aconteceu sob luz artificial, na cadeira odontológica, maca ou cadeira de rodas. Foram analisadas as seguintes condições: cárie dentária, gengivite, má oclusão (alterações de overbite e/ou overjet), anomalias dentárias e defeitos de desenvolvimento de esmalte (DDE). A examinadora foi previamente calibrada. Os valores de kappa e coeficiente de correlação intraclasse variaram de 0,76 a 0,98. Após as fases de calibração e estudo piloto, foi iniciado o estudo principal. Os dados foram analisados por meio do software Statistical Package for Social Science - SPSS® (versão 22.0). Foi realizada a análise univariada e bivariada. Por meio da análise bivariada (teste X2) verificou-se possíveis associações entre os grupos e as variáveis independentes (p<0,05). Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da UFMG. Este estudo será apresentado em formato de artigo científico. A média de idade dos pacientes foi de 13,9 anos (+7,2). A maioria deles foi de homens (58,6%), pretos ou pardos (70,7%) e de classe econômica favorecida ou mais favorecida (89,7%). As variáveis gengivite, má oclusão e anomalias dentárias foram estatisticamente significativas quando associadas ao grupo dos pacientes. A chance de ser diagnosticado com alguma má oclusão, anomalia dentária e/ou gengivite foi maior no grupo de pacientes com MPS. As anomalias identificadas foram giroversão, agenesia e outras (dente conóide e microdontia). Os resultados deste estudo pareado mostraram que existe uma prevalência maior de má oclusão, anomalias dentárias e gengivite entre os indivíduos com MPS do que entre aqueles sem MPS

Mucopolysaccharidosis (MPS) is a metabolic genetic disease caused by inborn errors of metabolism. It involves a number of physical, motor and intellectual disorders. Many of the physical disorders are present on the face and in the mouth. There are few studies devoted to MPS in the area of dentistry, and a lack of information on the dental characteristics of individuals with the disease. This study aimed to compare the oral characteristics of Brazilian individuals with MPS and without MPS. It will be presented into one manuscript. A paired cross-sectional study of 29 patients with MPS and 29 patients without MPS, aged between two and 25 years, was performed. Data was collected at a clinic of the School of Dentistry of the Universidade Federal de Minas Gerais (UFMG), in the city of Belo Horizonte, in the southeast of Brazil. Patients diagnosed with MPS at the Inborn Errors of Metabolism Clinic of the Clinical Hospital of UFMG and Hospital João Paulo II, together with their respective parents/guardians, were invited to participate in the study. The patients without MPS were selected from the Bias Fortes outpatient clinic (pediatric sector) and São Vicente de Paula outpatient clinic (adolescent sector). Parents/guardians who agreed to participate completed a questionnaire about the individual, socioeconomic and behavioral aspects of their children. The oral cavity of patients with and without MPS was examined under artificial light, in a dental chair, stretcher or wheelchair. The following conditions were analyzed: dental caries, gingivitis, malocclusion (overbite and/or overjet), dental anomalies and developmental enamel defects (DED). The examiner had been previously calibrated. Kappa values and intraclass correlation coefficients ranged from 0.76 to 0.98. Following calibration and a pilot study, the main study was performed. The data obtained was analyzed using the Statistical Package for Social Science - SPSS® (version 22.0) software. Univariate and bivariate analysis was performed. Bivariate analysis (X2 test) identified possible associations between the groups and the independent variables (p<0.05). The study was approved by the Human Research Ethics Committee of the UFMG. The mean age of the patients was 13.9 years (+7.2). The majority of them was male (58.6%), black/brown skin color (70.7%) and from favored or more favored economic classes (89.7%). There was a statistically significant association between the group of MPS patients and the variables gingivitis, malocclusion and dental anomalies. The chance of being diagnosed with a malocclusion, dental anomaly and/or gingivitis was higher in patients with MPS. The anomalies identified were giroversion, agenesis and others (conoid teeth and microdontia). The results of this paired study revealed a greater prevalence of malocclusion, dental anomalies and gingivitis among individuals with MPS than those without MPS

Perfil epidemiológico dos pacientes com necessidades especiais atendidos em um centro de especialidades odontológicas do interior baiano / El perfil epidemiológico de los pacientes con necesidades especiales atendidos en centro de especialidades odontológicas del interior baiano / Epidemiological profile of patients with special needs attended at a dental specialty center in the interior of the state of Bahia

O Centro de Especialidades Odontológicas (CEO) configura uma das estratégias da Política Nacional de Saúde Bucal. Dentre as especialidades atendidas, oferece tratamentoaos portadores de necessidades especiais, assegurando-os o pleno exercício de seus direitosà saúde. Este estudo objetivou descrever o perfil epidemiológico dos pacientes portadores denecessidades especiais atendidos no CEO de Feira de Santana (BA), no período de agosto de 2006 a dezembro de 2008. Foram analisados 361 prontuários. A cárie dentária e a doença periodontal foram as afecções bucais mais frequentes. Os dados coletados foram dispostos no SPSS, versão 17.0, para análise descritiva. Do total de participantes, 185 (52,2 por cento) eram homens e 176 (47,8 por cento), mulheres, sendo a deficiência mental a condição mais prevalente,com 106 pacientes (29,3 por cento). O planejamento odontológico foi concluído em 126 (35 por cento)desses pacientes. O reconhecimento dos fatores associados à manifestação clínica das afecções bucais mais prevalentes estabelece subsídios para ações específicas ao público-alvo,sedimentando a promoção de saúde bucal aos pacientes especiais...

Dental Specialty Centers constitute one of the strategies of the National OralHealth Policy. Among the specialties attended, these centers provide treatment for individualswith special needs, thus assuring them of full access to their healthcare rights. This studyhad the aim of describing the epidemiological profile of the clientele attended at the DentalSpecialty Center of Feira de Santana (BA), between August 2006 and December 2008.The medical files of 361 patients were analyzed. The dental carie and periodontal diseasewere the most prevalent oral diseases. The data gathered were entered into the SPSS, version17.0, for descriptive analysis. Of these patients, 185 (52.2 percent) were men and 176 (47.8 percent)were women, and mental deficiency was the most prevalent condition, affecting 106 patients(29.3 percent). Dental planning was concluded for 126 (35 percent) of these patients. Recognition offactors associated with the clinical manifestations of the most prevalent oral diseases providesbacking for specific actions among the target public, thereby enabling oral health promotionamong special patients...

El Centro de Especialidades Odontológicas (CEO) configura una de lasestrategias de la Política Nacional de la Salud Bucal. Entre las especialidades atendidas, ofrecetratamiento a los portadores de necesidades especiales, garantizándoles el total ejercicio desus derechos a la salud. Este estudio tuvo como objetivo describir el perfil epidemiológico delos pacientes portadores de necesidades especiales atendidos en CEO de Feira de Santanaen el periodo de agosto de 2006 hasta diciembre de 2008. Fueron analizados los historialesmédicos de 361 pacientes poseedores de necesidades especiales. La caries dental y laenfermedad periodontal fueron las enfermedades bucales más frecuentes. Los datos recogidosfueron puestos a disposición en el Statistical Package for the Social Sciences versión 17.0, para análisis descriptivo. De estos, 185 (52,2 por ciento) eran hombres y 176 (47,8 por ciento) mujeres, siendola minusvalía mental la condición más presente con 106 pacientes (29,3 por ciento). El planeamientoodontológico fue concluido en 126 (35 por ciento) de esos pacientes. El reconocimiento de los factoresrelacionados a la manifestación clínica de las afecciones bucales más presentes, establecesubsidios para acciones específicas al público meta, consolidando la promoción de la saludbucal a los pacientes especiales...

One year survival of ART and conventional restorations in patients with disability.

BACKGROUND: Providing restorative treatment for persons with disability may be challenging and has been related to the patient's ability to cope with the anxiety engendered by treatment and to cooperate fully with the demands of the clinical situation. The aim of the present study was to assess the survival rate of ART restorations compared to conventional restorations in people with disability referred for special care dentistry. METHODS: Three treatment protocols were distinguished: ART (hand instruments/high-viscosity glass-ionomer); conventional restorative treatment (rotary instrumentation/resin composite) in the clinic (CRT/clinic) and under general anaesthesia (CRT/GA). Patients were referred for restorative care to a special care centre and treated by one of two specialists. Patients and/or their caregivers were provided with written and verbal information regarding the proposed techniques, and selected the type of treatment they were to receive. Treatment was provided as selected but if this option proved clinically unfeasible one of the alternative techniques was subsequently proposed. Evaluation of restoration survival was performed by two independent trained and calibrated examiners using established ART restoration assessment codes at 6 months and 12 months. The Proportional Hazard model with frailty corrections was applied to calculate survival estimates over a one year period. RESULTS: 66 patients (13.6 ± 7.8 years) with 16 different medical disorders participated. CRT/clinic proved feasible for 5 patients (7.5%), the ART approach for 47 patients (71.2%), and 14 patients received CRT/GA (21.2%). In all, 298 dentine carious lesions were restored in primary and permanent teeth, 182 (ART), 21 (CRT/clinic) and 95 (CRT/GA). The 1-year survival rates and jackknife standard error of ART and CRT restorations were 97.8 ± 1.0% and 90.5 ± 3.2%, respectively (p = 0.01). CONCLUSIONS: These short-term results indicate that ART appears to be an effective treatment protocol for treating patients with disability restoratively, many of whom have difficulty coping with the conventional restorative treatment. TRIAL REGISTRATION NUMBER: Netherlands Trial Registration: NTR 4400.

Dental needs and management of children with special health care needs according to type of disability.

PURPOSE: The purpose of this study was to investigate the dental needs and management of special health care needs children in Rio de Janeiro, Brazil, according to the type of disability. METHODS: Records of 428 0- to 19-year-old patients who received dental treatment at the Patients Special Care Needs Clinic (Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro) from 1996-2009 were analyzed. Information about the type of disability, use of medication, dental exam findings, management during treatment, dental treatment performed, and follow-up examinations were collected. Children were divided into 2 groups: those with medical conditions and those with intellectual disability. RESULTS: Patients with medical conditions used more medications and were older than those with intellectual disability. The most common dental treatments received were dental restorations (63%) and extractions (47%). There was no association between the type of disability and dental treatment needed. Children with intellectual disability were 3 times more likely to need general anesthesia and 7 times more likely to need physical restraint for dental care than the other group. CONCLUSIONS: Children with intellectual disability have a greater chance of requiring advanced management techniques during dental treatment. The development of effective oral health programs is recommended as well as a specific education program for their parents.

Prevalence of dental trauma in individuals with special needs.

BACKGROUND: Individuals with special needs exist throughout the world. The last demographic census (IBGE, 2002) in Brazil indicated that 14.5% of the total population (24.5 million) present some type of impairment. This study aimed to evaluate the prevalence of dental trauma (DT) in individuals with special needs and the first attendance by a dental surgeon of patients admitted to the special care clinic of the School of Dentistry of Universidade Paulista (UNIP), Brazil, between 2001 and 2005. MATERIAL AND METHODS: The sample included 544 individuals with special needs aged 1-20 years old (mean 10.7 ± SD 5.3). Patient medical records were reviewed for demographic and clinical data, including medical diagnosis, gender, age, presence of DT and whether the attendance provided was the first time the patient had sought dental treatment. RESULTS: The individuals were distributed into 11 subgroups according to medical diagnosis. The DT prevalence determined was 9.2% (n = 50), with no difference in relation to gender. The majority (78.3%) of the individuals were seeking dental treatment for the first time at an advanced age. CONCLUSIONS: The present data suggest that DT prevalence in individuals presenting special needs is more common in permanent dentition and that the first attendance by a dental surgeon is delayed.

Avaliação da saúde bucal de deficientes visuais em Teresina-PI / Assessment of oral health of the visually impaired in Teresina-PI

A visão é considerada a grande promotora da interação humana em atividades motoras, perceptivas e mentais, e a perda desta pode provocar alterações no meio social. O objetivo deste trabalho foi avaliar a saúde bucal dos deficientes visuais por meio da análise da prevalência de cárie e doença periodontal, além da auto percepção e acessibilidade aos serviços odontológicos. O universo estudado consistiu em 42 deficientes visuais, de ambos os gêneros, na faixa etária de 18 a 63 anos de idade, regularmente matriculados na Associação dos Cegos do Piauí – ACEP, em Teresina-PI. Os dados foram processados nos programas Bio Estat 5.0 e EpiInfo 6.04b. O nível de significância foi estabelecido em 5% (p<0,05) e foram utilizados os testes estatísticos de Análise de Variância (ANOVA) e Teste post-hoc de Tukey. A média do índice CPO-D foi de 11,5, e 58% dos sextantes examinados apresentaram alterações periodontais. Realizaram-se questionamentos sobre a autopercepção em saúde bucal, e 83,2% dos entrevistados avaliaram a própria saúde bucal como excelente,boa ou regular. Além disso, 95,2% dos deficientes visuais relataram já ter ido ao cirurgião-dentista, mas apenas 30,9% disseram ter recebido orientações sobre saúde bucal nos últimos doze meses. Apesar dos deficientes visuais apresentarem uma autopercepção em saúde bucal positiva e acesso aos serviços odontológicos adequado, essa população apresentou uma situação clínica insatisfatória, com elevado índice CPO-D e grande número de sextantes alterados e excluídos, devido ao grande número de dentes ausentes.

[Utilization of oral health care for Down syndrome patients]. / Uso de serviços odontológicos por pacientes com síndrome de Down.

OBJECTIVE: From a perspective of comprehensive care, the purpose of the study was to evaluate factors associated to dental care provided to Down syndrome children and adolescents. METHODS: A cross-sectional study was carried out including 112 pairs of mothers/Down syndrome children aged between 3 and 18 years who attended a public hospital genetics clinic in Rio de Janeiro, Southeastern Brazil, in 2006. Dental care was not provided at the clinic. Data were collected through a questionnaire administered to the mothers and oral examinations of their children. Multiple logistic regression was used for data analysis. The dependent variable was "dental care of the Down syndrome child or adolescent" and the independent variables included demographic, socioeconomic and behavioral characteristics. RESULTS: Most children (79.5%) had had at least one dental visit (90% CI: 72.3; 87.8). Dental experience of the children was associated to the following variables: mothers who reported being advised by their children's health provider to take them to the dentist's (OR=6.1 [2.5; 15.1]); children with prior history of surgery (OR=2.5 [0.9; 7.1]); and age between 12 and 18 years (OR=13.1 [2.0; 86.9]). CONCLUSIONS: Dental care provided to Down syndrome children and adolescents was associated to advice given by their health providers, a part of comprehensive care.

A review of the oral health of individuals with disabilities in Puerto Rico and among U.S. Hispanics.

More than 51 million U.S. civilian noninstitutionalized residents have some form of long-lasting disability, including almost 1 million residents of Puerto Rico. The goal of this report is to review available data in an effort to stimulate recognition of the oral health needs of Puerto Rican residents with disabilities. The authors conducted a review using a series of U.S. Census Bureau reports to develop comparative relationships between Puerto Rican residents, the total U.S. population and the total U.S. Hispanic population. The review compared the proportion of these groups with disabilities, the proportion of the population who live below the poverty threshold, and oral health status. The review of available government and private agency data for the general population indicates that the percentage of Puerto Rican residents with disabilities is greater than the percentage of the total U.S. population and the total U.S. Hispanic population. In addition, compared to the total U.S. population, a greater percentage of total U.S. Hispanic children is living in poverty, has unmet dental needs, is uninsured for health services, and has not visited dentists for extended periods. Particularly limited information is available regarding the oral health needs and services for Puerto Rican residents with disabilities. It is essential for future government and private agency surveys and reports to emphasize the economic status of the Puerto Rican population, recognize the distribution of particular disabilities among the various racial/ethnic populations, and increase general attention to the oral health of the residents of Puerto Rico with specific concerns regarding individuals with disabilities.

General anesthesia: as a challenge and treatment need option in pediatric dentistry.

OBJECTIVE: The purpose of this study was to determine the type and characteristics of the interventions, indications of dental treatment and procedures performed to patients treated under general anesthesia (GA) by pediatric dentistry residents, during the 1997-1999 period. METHOD: A sample of 57 hospital records of patients treated as part of the Special Pediatric Course at the Puerto Rico Pediatric Hospital were reviewed. Statistical analysis was done using the chi-square test for inferences on proportions. RESULTS: MR patients made up 59.7% and NMR patients made up 40.3% of the sample studied. Ages ranged from 2 to 35 years with a mean age of 11 years (SD=8.54). MR patients were classified into 7 categories: mental retardation (38.2%), cerebral palsy (14.7%), epileptic (5.9%), mental syndromes (26.9%), hydrocephalic (5.9%), autism (5.9%) and others (2.9%). The NMR were classified into 5 categories: early childhood caries (65.2%), cardiac patients (8.7%), maxillofacial anomalies (4.3%), organic syndromes (13.1%) and others (8.7%). The dental procedures performed were: dental extractions 84%(MR) and 68% (NMR), restorative procedures 87.3%(MR) and 12.7%(NMR). Oral prophylaxis was performed in 76.8%, fissure sealants in 10.7% and topical fluoride applications in 21.8%. CONCLUSION: Dental extraction was a frequently performed procedure in both groups. The prevalence of exodontia and restorative procedures indicates the need to design and implement prevention programs for special pediatric patients.

Perfil de pacientes con necesidades especiales / Profile of patients with special needs

A pesar del aumento gradual del número de individuos portadores de necesidades especiales, los tratamientos más precoces, las terapias modernas y las nuevas propuestas educacionales están cambiando el perfil de estos pacientes estimulando su participación social como ciudadanos. El propósito de este trabajo fue evaluar el perfil de 378 pacientes concurrentes al Curso de Extensión Universitaria de la Facultad de Odontología (210 de sexo masculino y 168 de sexo femenino - proporción 1,25 a 1,0) de edades entre 2 meses y 60 años 9 meses (de 0-9 años 32,53 por ciento; 10-20 años 41 por ciento; 21-30 años 12,69 por ciento; más de 30 años 11,37 por ciento. El resultado demostró que las afecciones más frecuentes son: deficiencia neuromotora 26,98 por ciento; síndrome de Down 10,84 por ciento; epilepsia 7,40 por ciento, retardo mental sin otras alteraciones significativas 7,40 por ciento, hidrocefalia 3,44 por ciento; sin diagnóstico específico 19,84 por ciento. En el trabajo voluntario extramuro el curso desarrolla un programa odontológico de base educativa, preventiva y restauradora en 4 entidades con fines filantrópicos. 1- Casa del Niño Jesús de Praga, 42 niños abandonados entre 0-10 años, el 73 por ciento son portadores de dificiencias motoras. 2- Instituto Educacional Nazareth (APAE-POA) 110 pacientes de 32,72 por ciento son portadores de deficiencias neuromotoras. 3- Educandario San Joao Baptista Centro de Rehabilitación Física, 90 niños y adolescentes 41,11 por ciento con encefalopatía crónica no progresiva. 4- Casa del Excepcional Sanata Rita de Cassia, 42 niños 100 por ciento lesión neurológica severa totalmente dependientes de sus actividades diarias. El tratamiento odontológico del paciente con necesidades especiales debe ser iniciado precozmente, luego que el profesional haya evaluado su problema sistémico. Esto exige un abordaje multidisciplinario desafiando la formación tecnicista del odontólogo

Assistência dispensada à saúde bucal de pacientes psiquiátricos hospitalizados de Belo Horizonte / Oral health assistence for institutionalized psychiatric patients

A condição de saúde bucal dos portadores de transtornos mentais tem se mostrado inferior à da população em geral. Nesse estudo objetivou-se conhecer a atenção dispensada à saúde bucal de pacientes psiquiátricos hospitalizados da cidade de belo Horizonte (MG). Após levantamento de todas as instituições dessa cidade, 10 foram selecionadas para participarem do estudo com base no número de pacientes e no tempo médio de internação. Um funcionário de cada instituição respondeu a um questionário estruturado contendo 13 perguntas referentes à disponibilidade de serviços de assistência e prevenção em saúde bucal. Constatou-se que somente em 30 por cento das instituições há disponibilidade de seviço odontológico próprio, que as emergências são responsáveis por 90 por cento dos encaminhamentos aos cirurgiões-dentistas e que não há preocupação com a prática de higiene bucal dos pacientes

Perfil de pacientes con necesidades especiales / Profile of patients with special needs

A pesar del aumento gradual del número de individuos portadores de necesidades especiales, los tratamientos más precoces, las terapias modernas y las nuevas propuestas educacionales están cambiando el perfil de estos pacientes estimulando su participación social como ciudadanos. El propósito de este trabajo fue evaluar el perfil de 378 pacientes concurrentes al Curso de Extensión Universitaria de la Facultad de Odontología (210 de sexo masculino y 168 de sexo femenino - proporción 1,25 a 1,0) de edades entre 2 meses y 60 años 9 meses (de 0-9 años 32,53 por ciento; 10-20 años 41 por ciento; 21-30 años 12,69 por ciento; más de 30 años 11,37 por ciento. El resultado demostró que las afecciones más frecuentes son: deficiencia neuromotora 26,98 por ciento; síndrome de Down 10,84 por ciento; epilepsia 7,40 por ciento, retardo mental sin otras alteraciones significativas 7,40 por ciento, hidrocefalia 3,44 por ciento; sin diagnóstico específico 19,84 por ciento. En el trabajo voluntario extramuro el curso desarrolla un programa odontológico de base educativa, preventiva y restauradora en 4 entidades con fines filantrópicos. 1- Casa del Niño Jesús de Praga, 42 niños abandonados entre 0-10 años, el 73 por ciento son portadores de dificiencias motoras. 2- Instituto Educacional Nazareth (APAE-POA) 110 pacientes de 32,72 por ciento son portadores de deficiencias neuromotoras. 3- Educandario San Joao Baptista Centro de Rehabilitación Física, 90 niños y adolescentes 41,11 por ciento con encefalopatía crónica no progresiva. 4- Casa del Excepcional Sanata Rita de Cassia, 42 niños 100 por ciento lesión neurológica severa totalmente dependientes de sus actividades diarias. El tratamiento odontológico del paciente con necesidades especiales debe ser iniciado precozmente, luego que el profesional haya evaluado su problema sistémico. Esto exige un abordaje multidisciplinario desafiando la formación tecnicista del odontólogo (AU)