COVID-19: ¿una oportunidad para la toma de conciencia sobre el cuidado integral del odontólogo? / COVID-19: An opportunity to raise awareness about dentists' holistic wellbeing?

La pandemia de COVID-19 generó en la comunidad odon- tológica argentina un profundo desconcierto e incertidumbre frente a su práctica profesional, su economía y su cuidado. Mediante un cuestionario difundido a través de redes so- ciales en octubre de 2020, se formularon preguntas vinculadas al ejercicio profesional en ese contexto y otras en las que se incluyeron variables referidas a signos de ansiedad, depresión y resiliencia. Los odontólogos presentaron signos de estrés, ansiedad, tensión emocional, dificultad para conciliar el sueño, senti- mientos de culpa y sensación de soledad. Manifestaron casi en su totalidad que su esfuerzo y el cuidado de su persona frente a este nuevo paradigma no son valorados por el sistema de salud y que se evidencia en la escasa retribución que perciben por sus prestaciones. Las conclusiones tienen el mandato del cambio pues los datos arrojados por la encuesta y el sentir manifestado con vehemencia y desolación ponen sobre la mesa la necesidad de iniciar una nueva etapa (AU)

The COVID-19 pandemic created a profound state of be- wilderment and uncertainty among dentists regarding their professional practice, economy and personal care. An online survey posted on social media in October 2020 asked ques- tions about professional practice in this context and other variables such as signs of anxiety, depression and resilience. Dentists reported signs of stress, anxiety, emotional tension, difficulty to get to sleep, and feelings of guilt and loneliness. Most of them felt that the efforts they made to do their job and ensure their personal care in this new paradigm were not valued by the healthcare system, as reflected by the low compensation for their services. From the data obtained through the survey and the feelings of vehemence and grief expressed by respondents, it is concluded there is a need for action and change (AU)

COVID-19 pandemic impact on dentists in Latin America's epicenter: São-Paulo, Brazil.

The state of São Paulo, Brazil, where more than 94.000 dentists are currently registered, has become the epicenter of COVID-19 in Latin America. The aim of this cross-sectional study was to evaluate the impact of COVID-19 pandemic on dentists in this state. A semi-structured questionnaire was sent via e-mail to 93.280 dentists with active registration in the Dental Council of São Paulo (CROSP). The impact of COVID-19 pandemic was assessed through questions related to demographic, socioeconomic, dental practice characteristics and personal protective equipment (PPE) use. Ordinal logistic regression analysis was performed to investigate the association between all the variables (p<0.05). Over 8 days, 2113 responses were received. Only 26.52% of the sample reported a low-income reduction (from 0-10%), while the majority of dentists reported a more negative financial impact, 35.6% with a reduction of more than 50% of their monthly income. Dentists who worked in the private sector and at the capital had a greater financial impact when compared to those of the public sector and countryside of the state (p<0.05). Furthermore, about 83% reported not having received any specific training to control the transmission of coronavirus in the health area. This study provides evidence of the negative impact of the COVID-19 pandemic on the routine of dentists in the state of São Paulo, Brazil. Hopefully, this study will help dental and other health care professionals to better understand the consequences of disease in dental settings and strengthen preparedness throughout the dental health care system.

Precarisation of dentistry in private healthcare: bioethical analysis. / Precarização do trabalho odontológico na saúde suplementar: uma análise bioética.

The present study highlighted the labour process of the dental surgeon (DS) in the private healthcare sector from the healthcare professional's perspective based on intervention bioethics. An observational, cross-sectional survey study was performed within the Federal District (Distrito Federal) region. Data were collected from 108 questionnaires completed by DSs affiliated with two types of private health insurers, self-insurance and group insurance, to assess job perception and the degree of job satisfaction in the dentistry market. The main source of dissatisfaction for healthcare professionals was related to the pay for dental procedures by insurers. For self-insurer 1, 38.1% healthcare professionals replied that the pay was satisfactory, whereas in self-insurance 2 and in the group insurance, 100% of healthcare professionals were dissatisfied. Another finding was that the group insurer considerably restricted elective treatments. In conclusion, loss of professional autonomy, depreciation of insurance claims and precarisation of dentistry occurs in the private healthcare sector, thus demonstrating the ethical conflicts in this relationship.

O presente trabalho evidenciou o processo de trabalho do cirurgião-dentista (CD) no setor de saúde suplementar a partir da visão do profissional, sob a luz da Bioética de Intervenção. Foi realizado um estudo observacional-seccional do tipo inquérito circunscrito à região do Distrito Federal. Os dados foram coletados por meio de 108 questionários respondidos por CDs credenciados à duas modalidades de operadora: autogestão e odontologia de grupo, com a finalidade de conhecer a percepção e o grau de satisfação profissional diante do mercado de trabalho odontológico. A insatisfação maior por parte dos profissionais foi relacionada à remuneração dos trabalhos odontológicos pelas operadoras. Para a operadora de autogestão 1, 38,1% dos profissionais responderam que a remuneração era satisfatória, enquanto para a de autogestão 2 e odontologia de grupo, houve 100% de insatisfação. Outro dado encontrado foi que a operadora de odontologia de grupo restringiu os tratamentos selecionados aos pacientes de forma expressiva. Conclui-se que existe a perda de autonomia profissional, desvalorização dos ressarcimentos e precarização do trabalho odontológico na saúde suplementar, demonstrando conflitos éticos nessa relação de trabalho.

Precarização do trabalho odontológico na saúde suplementar: uma análise bioética / Precarisation of dentistry in private healthcare: bioethical analysis

Resumo O presente trabalho evidenciou o processo de trabalho do cirurgião-dentista (CD) no setor de saúde suplementar a partir da visão do profissional, sob a luz da Bioética de Intervenção. Foi realizado um estudo observacional-seccional do tipo inquérito circunscrito à região do Distrito Federal. Os dados foram coletados por meio de 108 questionários respondidos por CDs credenciados à duas modalidades de operadora: autogestão e odontologia de grupo, com a finalidade de conhecer a percepção e o grau de satisfação profissional diante do mercado de trabalho odontológico. A insatisfação maior por parte dos profissionais foi relacionada à remuneração dos trabalhos odontológicos pelas operadoras. Para a operadora de autogestão 1, 38,1% dos profissionais responderam que a remuneração era satisfatória, enquanto para a de autogestão 2 e odontologia de grupo, houve 100% de insatisfação. Outro dado encontrado foi que a operadora de odontologia de grupo restringiu os tratamentos selecionados aos pacientes de forma expressiva. Conclui-se que existe a perda de autonomia profissional, desvalorização dos ressarcimentos e precarização do trabalho odontológico na saúde suplementar, demonstrando conflitos éticos nessa relação de trabalho.

Abstract The present study highlighted the labour process of the dental surgeon (DS) in the private healthcare sector from the healthcare professional's perspective based on intervention bioethics. An observational, cross-sectional survey study was performed within the Federal District (Distrito Federal) region. Data were collected from 108 questionnaires completed by DSs affiliated with two types of private health insurers, self-insurance and group insurance, to assess job perception and the degree of job satisfaction in the dentistry market. The main source of dissatisfaction for healthcare professionals was related to the pay for dental procedures by insurers. For self-insurer 1, 38.1% healthcare professionals replied that the pay was satisfactory, whereas in self-insurance 2 and in the group insurance, 100% of healthcare professionals were dissatisfied. Another finding was that the group insurer considerably restricted elective treatments. In conclusion, loss of professional autonomy, depreciation of insurance claims and precarisation of dentistry occurs in the private healthcare sector, thus demonstrating the ethical conflicts in this relationship.

A randomized trial on simplified and conventional methods for complete denture fabrication: cost analysis.

PURPOSE: This study aimed to quantify the costs of complete denture fabrication by a simplified method compared with a conventional protocol. MATERIALS AND METHODS: A sample of edentulous patients needing conventional maxillary and mandibular complete dentures was randomly divided into group S, which received dentures fabricated by a simplified method, and group C, which received conventionally fabricated dentures. We calculated direct and indirect costs for each participant including unscheduled procedures. This study assessed 19 and 20 participants allocated into groups S and C, respectively, and comparisons between groups were conducted by the Mann-Whitney and Student's t-test (α = 0.05). RESULTS: Complete denture fabrication demanded median time periods of 173.2 and 284.5 minutes from the operator for groups S and C respectively, and 46.6 and 61.7 minutes from the dental assistant (significant differences, p < 0.05). There was no difference between groups regarding postinsertion adjustments. Group S showed lower values for costs with materials and time spent by patients than group C during the fabrication stage, but not during adjustments. CONCLUSIONS: The median direct cost of complete denture treatment was 34.9% lower for the simplified method. It can be concluded that the simplified method is less costly for patients and the health system when compared with a conventional protocol for the rehabilitation of edentulous patients.

Cost-effectiveness of the introduction of specialized oral care with laser therapy in hematopoietic stem cell transplantation.

Oral mucositis (OM) is one of the side effects of hematopoietic stem cell transplantation (HSCT), resulting in major morbidity. The aim of this study was to determine the cost-effectiveness of the introduction of a specialized oral care program including laser therapy in the care of patients receiving HSCT with regard to morbidity associated with OM. Clinical information was gathered on 167 patients undergoing HSCT and divided according to the presence (n = 91) or absence (n = 76) of laser therapy and oral care. Cost analysis included daily hospital fees, parenteral nutrition (PN) and prescription of opioids. It was observed that the group without laser therapy (group II) showed a higher frequency of severe degrees of OM (relative risk = 16.8, 95% confidence interval -5.8 to 48.9, p < 0.001), with a significant association between this severity and the use of PN (p = 0.001), prescription of opioids (p < 0.001), pain in the oral cavity (p = 0.003) and fever > 37.8°C (p = 0.005). Hospitalization costs in this group were up to 30% higher. The introduction of oral care by a multidisciplinary staff including laser therapy helps reduce morbidity resulting from OM and, consequently, helps minimize hospitalization costs associated with HSCT, even considering therapy costs.

Análisis de los criterios establecidos por el cirujano dentista ante la fijación de honorarios y la forma de pago / Analysis of the criteria established by the dental surgeon for the application of fees and payment modalities

Toda actividad humana que se convierte en utilidad se debe pagar de alguna manera. Se denominan honorarios la forma de remuneración a aquellos que ejercen una profesión liberal, es decir, que poseen un acopio técnico-científico y cultural propio. En la odontología es muy difícil el estandarizarse honorarios, puesto que, principalmente en el ejercicio privado, es grande el número de las variables del profesional, del paciente, de la comunidad y del caso en sí mismo que condicionan los costes. El código de ética odontológica no conceptúa honorarios, sólo establece criterios, sin obligar, autorizar o prohibir al profesional que estipule honorarios. El objetivo del presente trabajo fue verificar junto a los cirujanos-dentistas de las ciudades de Jales y Santa Fé do Sul, Estado de São Paulo, Brasil, cómo se hacen los análisis de los criterios establecidos por el cirujano-dentista ante a la fijación de honorarios y a la forma de pago. Se ha aplicado un cuestionario conteniendo preguntas abiertas y cerradas a 100 cirujanos-dentistas registrados en el Consejo Regional de Odontología. Evaluándose los resultados, observamos que la mayoría, o sea, el 46,5 por ciento de los entrevistados afirmó que recibe sus honorarios en cheque y se lleva en cuenta la complejidad del caso para establecerlos (25,6 por ciento); el 54,6 por ciento fija sus honorarios basados en alguna tabla; el 19,8 por ciento no considera justo lo que recibe y el 60,5 por ciento ya ha tenido problemas con incumplimiento. A través de los resultados se puede verificar que gran parte de los cirujanos-dentistas sienten dificultades en establecer sus honorarios y además se encuentran insatisfechos con lo que reciben.

Every human service that is transformed into utility must be paid by certain way. It is known as honorarium the remuneration paid to those who exert a liberal profession, that is, those that have a technical-scientific and cultural heap of their own. In dentistry, it is very difficult to standardize the honorarium due to the great amount of professional variables, derived from patients, from the community and from the individuality of each clinical case, which condition the costs. According to dental ethics code, honorarium is not conceptualized, but criteria are established without obliging, authorizing or prohibiting the professional to estimate the honorarium. The aim of this study was to verify the criteria applied by dental surgeons from Jales and Santa Fe do Sul - SP, to establish their honorarium, as well as the way of payment. A questionnaire containing dissertative and multiple - choice tests was applied to 100 members of the Regional Dentistry Council of this cities. The results indicated most of the subjects, that is, 46,5% received their honorarium by checks and the values were established according to the complexity of clinical case ( 25,6% ); 54,6% determined their honorarium based upon some tables, for 19,8% of the subjects, their honorarium was not considered to be fair and 60% had problems with debtor patients. Through these result one can conclude most of the dentists felt difficulty in establishing their honorarium and considered that their remuneration was not fair.

Toda atividade humana que se transforma em utilidade deve ser paga de alguma forma. Denominam-se honorários a forma de remuneração àqueles que exercem uma profissão liberal, isto é, que possuem um acervo técnico-científico e cultural próprio. Em odontologia é muito difícil se padronizar honorários, pois, principalmente entre autônomos, é grande o número de variáveis do profissional, do paciente, da comunidade e do caso em si que condicionam os custos. O Código de ética odontológico não conceitua honorários, apenas estabelece critérios, sem obrigar, autorizar ou proibir o profissional de estipular honorários. O objetivo do presente trabalho foi verificar, junto aos cirurgiões-dentistas das cidades de Jales e Santa Fé do Sul - SP, como são feitas as análises dos critérios estabelecidos pelo cirurgião-dentista frente à fixação de honorários e ao tipo de pagamento. Foi aplicado um questionário contendo questões abertas e fechadas à 100 cirurgiões-dentistas cadastrados no CRO dessas regiões. Analisando-se os resultados observamos que a maioria, ou seja, 46,5% dos entrevistados afirmaram receber seus honorários em cheque e levam em consideração a complexidade do caso para estabelecê-los (25,6%); 54,6% fixa seus honorários baseados em alguma tabela; 19,8% não acha justo o que recebem e 60,5% já tiveram problemas com inadimplência. A partir dos resultados pode-se verificar que grande parte dos cirurgiões-dentistas sentem dificuldades de estabelecer seus honorários além de estarem insatisfeitos com o que recebem.

El egresado de odontología frente a los cambios socioeconómicos en México / The dental graduate facing socioeconomic changes in Mexico

El presente artículo describe las posibilidades que tiene el profesional recién egresado en odontología para obtener un modo de vida decente y poder solventar desahogadamente sus costos de vida. Nos da un panorama real en donde el egresado analiza sus posibilidades de entrar en un mercado de trabajo, que por factores ajenos a él es cada vez más complicado. A la vez, dichos estudiantes se ven cuestionados antes la alternativa (o no) de su proyección profesional, después de haber hecho una cuantiosa inversión científica de varios años y haberse motivado a través del curso de la carrera de cirujano dentista. Por último, ubican al gremio de los odontólogos en un contexto de ingresos reales (más bajos) comparados con los de otros profesionales, y más bajos aún ubicados en un mercado laboral nacional de empleados calificados que reciben una remuneración subvaluada en proporción a su esfuerzo, dedicación y grado de dificultad de los trabajos realizados