The Role of Socioeconomic and Health Services Organizational Factors on Infection Control Structure Score, Brazil.

This study aimed to analyze possible associations between the Infection Control Structure Score (ICSS), health services, and social characteristics of the municipalities in Brazil. Secondary data from the third cycle 2017-2018 of the Brazilian National Program for Improving Primary Care Access and Quality (PMAQ) was analyzed. Six independent variables - FIRJAN Index of Municipal Development, number of inhabitants, number of family health teams receiving a financial incentive from the federal government, healthcare expenditure per capita, and number of Oral Health Teams modalities 1 and 2 - were included to assess their influence on ICSS, measured for each Brazilian town. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25. A total of 4,900 municipalities were included, and the mean ICSS was 0.905 (±0.092). A positive relationship was observed between healthcare expenditure per capita, municipal development, and the outcome. Conversely, towns with a higher number of family health teams receiving a financial incentive from the federal government showed lower mean ICSS. The findings suggest that inequalities in the infection control structures exist within the country, and they were related to the health services and social characteristics of the municipalities.

The Role of Socioeconomic and Health Services Organizational Factors on Infection Control Structure Score, Brazil / O Papel dos Fatores Socioeconômicos e de Organização dos Serviços de Saúde sobre o Escore da Estrutura de Controle de Infecção, Brasil

Abstract This study aimed to analyze possible associations between the Infection Control Structure Score (ICSS), health services, and social characteristics of the municipalities in Brazil. Secondary data from the third cycle 2017-2018 of the Brazilian National Program for Improving Primary Care Access and Quality (PMAQ) was analyzed. Six independent variables - FIRJAN Index of Municipal Development, number of inhabitants, number of family health teams receiving a financial incentive from the federal government, healthcare expenditure per capita, and number of Oral Health Teams modalities 1 and 2 - were included to assess their influence on ICSS, measured for each Brazilian town. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25. A total of 4,900 municipalities were included, and the mean ICSS was 0.905 (±0.092). A positive relationship was observed between healthcare expenditure per capita, municipal development, and the outcome. Conversely, towns with a higher number of family health teams receiving a financial incentive from the federal government showed lower mean ICSS. The findings suggest that inequalities in the infection control structures exist within the country, and they were related to the health services and social characteristics of the municipalities.

Resumo Este estudo objetivou analisar as possíveis associações entre o Escore da Estrutura de Controle de Infecção (EECI), os serviços de saúde e características sociais dos municípios brasileiros. Foram analisados dados secundários do terceiro ciclo 2017-2018 do Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ). Seis variáveis independentes - Índice FIRJAN de Desenvolvimento Municipal, número de habitantes, número de Equipes de Saúde da Família que recebiam incentivo financeiro do governo federal, gasto com saúde per capita e número de Equipes de Saúde Bucal modalidades 1 e 2 - foram incluídas para avaliar a influência sobre o EECI, medido para cada município brasileiro. Para a análise dos dados, foi utilizado o modelo de Árvore de Classificação e Regressão no IBM SPSS 25. Foram incluídos 4.900 municípios, e o EECI médio foi de 0,905 (±0,092). Observou-se uma associação positiva entre o gasto com saúde per capita, o desenvolvimento municipal e o desfecho. Por outro lado, municípios com maior número de Equipes de Saúde da Família com incentivo financeiro do governo federal apresentaram menor média do EECI. Os achados sugerem que existem desigualdades nas estruturas de controle de infecções no país, relacionadas aos serviços de saúde e às características sociais dos municípios.

Reliability analysis using the in-lux examination method for dental indices in adolescents for use in epidemiological studies.

OBJECTIVE: To evaluate the in-lux examination method to assess the reliability of examiners for oral health surveys. METHODS: A calibration study involving 10 examiners and 27 patients was conducted, and high-quality photographs of dental epidemiological indices were projected. The latter refers to the in-lux examination method. Two groups, comprised of five examiners each, were trained to assess dental caries (DMFT index) and malocclusion (DAI). The first group carried out in vivo (clinical) and in-lux examinations in the same patients. The second group performed in-lux examinations only. The measurements were repeated to obtain intraexaminer weighted kappa coefficients. RESULTS: Interexaminer weighted kappa coefficients of the in vivo examination method for DMFT and DAI ranged from 0.597 to 0.851 and from 0.574 to 0.844, respectively. The values for in-lux examination were between 0.440 and 0.856 (DMFT) and between 0.524 and 0.783 (DAI). The intraexaminer kappa coefficients of the in vivo examination method ranged between 0.569 and 0.851 (DMFT) and between 0.644 and 0.834 (DAI). In the in-lux method, these values were between 0.426 and 0.831 (DMFT) and between 0.341 and 0.838 (DAI). Three examiners did not reach the minimum acceptable kappa value (k = 0.610) for DMFT, and one for DAI. Of these, one examiner managed to reach the minimum kappa coefficient for DMFT after additional training. The three others maintained the kappa coefficients at lower than acceptable limits. CONCLUSIONS: Calibration, using both in vivo and in-lux examination methods, was able to discriminate the examiners regarding their reliability to reproduce dental indices. The in-lux examination method was considered reliable and can replace the in vivo examination method. The in-lux method might be more feasible to evaluate the reliability of examiners when clinical calibration is unrealistic due to logistic issues and when a large number of examiners are involved in the survey.

O papel do preceptor na formação profissional em serviço de saúde / The role of the preceptor in professional training in health services

O estudo objetivou avaliar o papel do preceptor na formação do estudante de Odontologia na disciplina "Estágio Supervisionado em Odontologia" da Faculdade de Odontologia da UFMG. Foi utilizado um questionário com questões abertas e fechadas sobre as experiências e impressões dos estudantes, professores e preceptores de seis campos de estágio localizados em Belo Horizonte. Onze estudantes, dez preceptores e quatro professores participaram deste estudo. Todos os alunos e professores e 50% dos preceptores consideram que a preceptoria faz parte das atribuições do profissional de saúde. A maioria dos atores afirmou que o profissional de saúde se sente motivado e preparado para atuar como preceptor. Todos os atores consideraram importante a participação do estudante em estágios em serviços de saúde durante a formação profissional e afirmaram que o preceptor tem conhecimento sobre os objetivos da disciplina. Apenas 20% dos preceptores afirmaram que já participaram de curso de capacitação de preceptoria e 80% manifestaram interesse em participar. A percepção dos participantes sobre o papel do preceptor na formação do profissional de saúde foi positiva. Alguns preceptores não têm consciência de que a preceptoria faz parte de sua atribuição como profissional da saúde. São necessárias ações que busquem capacitar e conscientizar os preceptores do seu papel na formação dos futuros profissionais de saúde (AU).

The study aimed to evaluate the role of the preceptor in the training of dentistry students in the discipline "Supervised Internship in Dentistry" at the Faculty of Dentistry at UFMG.A questionnaire with open and closed questions about the experiences and impressions of students, teachers and tutors from six internship fields located in Belo Horizonte was used. Eleven students, ten preceptors and four professors participated in this study. All students and professors and 50% of preceptors consider that preceptorship is part of the health professional's attributions. Most actors stated that the health professional feels motivated and prepared to act as a preceptor. All actors consideredimportant the student's participation in internships in health services during professional training and stated that the preceptor knows about the discipline's objectives. Only 20% of preceptors said they had already participated in a preceptorship training course and 80% expressed interest in participating. The participants' perception of the role of the preceptor in the training of health professionals was positive. Some preceptors are not aware that preceptorship is part of their role as health professional. Actions that seek to train and make preceptors aware of their role in trainingfuture health professionals are needed (AU).

A Description of Infection Control Structure in Primary Dental Health Care, Brazil.

OBJECTIVE: This study is aimed at describing a score to assess infection control structures in Oral Health Teams (OHT) in Primary Health Care (PHC) in Brazil. METHODS: Secondary data from a national external evaluation of PHC conducted in 2017 and 2018 were analyzed. The construction of the score used 14 variables, divided into the following: structural characteristics of the PHC, infection control equipment under conditions of use, and biosafety supplies in sufficient quantity. The questions were mostly dichotomous (yes/no). Descriptive analyses were carried out to characterize the OHT and factor analyses to reduce the number of observed variables to a specific number of factors. RESULTS: Among 20,301 health units with OHT, 4,510 (22.2%) units did not have washable floors, ceilings, and walls; 8,406 (41.4%) did not have a sealer; 16,780 (82.7%) did not have taps with noncontact activation, and 4,663 (23.0%) units did not have rubber gloves. Regarding personal protective equipment (PPE), 1,618 (8.0%) units did not have a sufficient quantity of basic PPE. Three factors were defined to explain the 14 evaluated variables. The South region had the best score of infection control, while the North had the worst. CONCLUSIONS: Regional inequalities in the failures in infection control structures identified in PHC with OHT were related to the physical structure, equipment, and supplies used for infection control and the absence of PPE for OHT.

Biossegurança em Odontologia: conduta dos estudantes antes e após uma ação educativa / Biosafety in Dentistry: conduct of students before and after an educational intervention

O objetivo do estudo foi avaliar o conhecimento e a adesão dos estudantes de graduação em Odontologia da Universidade Federal de Minas Gerais quanto às normas de biossegurança e controle da infecção. Trata-se de um estudo transversal descritivo realizado com alunos do 4° ao 10° período, matriculados no segundo semestre de 2017. Houve uma intervenção que buscou reforçar os conhecimentos de biossegurança por meio da distribuição de folhetos informativos aos estudantes e afixação de pôsteres em locais de maior circulação. Foram coletadas informações sociodemográficas e relativas à biossegurança antes e após a intervenção, por meio de um questionário validado. Foram realizadas análises descritivas e bivariada por meio do teste qui-quadrado. A amostra constituiu de 653 estudantes, a maioria do sexo feminino, cursando entre o 7° e o 10° períodos, com média de idade de 22,6 anos. Quanto à proteção mecânica dos instrumentos de trabalho, tanto antes quanto após a ação, mais de 80% responderam sempre utilizar barreiras. Houve redução das frequências de desinfecção do ambiente e uso de equipamentos de proteção individual. A frequência de lavagem dos instrumentais aumentou de 95,4% para 96,6% após a intervenção, enquanto a esterilização reduziu de 100% para 98,8%. Houve associação entre o uso de equipamentos de proteção individual com o sexo feminino e os períodos iniciais do curso (p<0,001). Conclui-se que os estudantes do sexo feminino e dos períodos iniciais aderem com maior frequência às normas de biossegurança. Os conhecimentos sobre biossegurança não foram satisfatórios para o controle da infecção, mesmo após a ação educativa (AU).

The objective of this study was to evaluate the knowledge of and adherence to biosafety and infection control norms of dental students. This was a cross-sectional descriptive study carried out with students from 4th to 10th semester, enrolled in the second half of 2017. Na educational intervention to reinforce biosafety knowledge was implemented through the distribution of information flyers to students and poster placement in areas of high pedestrian circulation. Sociodemographic and biosafety information was collected before and after the intervention using a validated questionnaire. Descriptive and bivariate analyses were performed with the chi-square test using SPSS software, version 19. The research was approved by the Research Ethics Committee. The sample consisted of 653 students, most of them female, between the 7th and 10th semesters, with a mean age of 22.6 years. Before and after the intervention, more than 80% always used physical protection barriers. The frequency of environment disinfection and use of personal protection equipment decreased after the intervention. Always performing instrument washing increased from 95.4% to 96.6% after the intervention, while sterilization decreased from 100% to 98.8%. There was an association between the use of personal protection equipment with being women and with semestre (p <0.001). We conclude that students in initial semesters more often adhere to biosafety standards. Knowledge about biosafety was not satisfactory for infection control even after the educational intervention (AU).

A Survey About Dental Instruments at the Primary Health Care in Brazil.

This study describes the structure of oral health services in primary health care in Brazil and the instruments available for the provision of oral health care and to compare the number of instruments according to organizational characteristics of health services and among the macroregions. Of the 23,251 oral health teams (OHTs) in the Public Health System, 17,513 (75.3%) participated in this study. Trained researchers observed the structures of the health services and determined the presence of and whether a sufficient quantity of 36 dental instruments existed. The score of each oral health service was determined by the sum of the number of dental instruments present in sufficient quantity (0 to 36). Central tendency measures were compared along with the variability in these scores according to the organizational characteristics of the services and according to the Brazilian macroregion. No instrument was found to be present in all evaluated services. Basic, surgical and restorative instruments were the most frequently found. Periodontal, endodontic and prosthetic instruments exhibited the lowest percentages. The mean and median numbers of dental instruments were higher for teams that operated over more shifts, those with an oral health technician and those in the South and Southeast regions. The oral health services were equipped with basic, surgical and restorative instruments. Instruments designed for periodontal diagnosis, emergency care and denture rehabilitation were less frequently found in these services. The worst infrastructure conditions existed in the OHTs with the worst forms of care organization and in regions with greater social issues.

A survey about dental instruments at the primary health care in Brazil

Abstract This study describes the structure of oral health services in primary health care in Brazil and the instruments available for the provision of oral health care and to compare the number of instruments according to organizational characteristics of health services and among the macroregions. Of the 23,251 oral health teams (OHTs) in the Public Health System, 17,513 (75.3%) participated in this study. Trained researchers observed the structures of the health services and determined the presence of and whether a sufficient quantity of 36 dental instruments existed. The score of each oral health service was determined by the sum of the number of dental instruments present in sufficient quantity (0 to 36). Central tendency measures were compared along with the variability in these scores according to the organizational characteristics of the services and according to the Brazilian macroregion. No instrument was found to be present in all evaluated services. Basic, surgical and restorative instruments were the most frequently found. Periodontal, endodontic and prosthetic instruments exhibited the lowest percentages. The mean and median numbers of dental instruments were higher for teams that operated over more shifts, those with an oral health technician and those in the South and Southeast regions. The oral health services were equipped with basic, surgical and restorative instruments. Instruments designed for periodontal diagnosis, emergency care and denture rehabilitation were less frequently found in these services. The worst infrastructure conditions existed in the OHTs with the worst forms of care organization and in regions with greater social issues.

Resumo Este estudo descreve a estrutura dos serviços de saúde bucal na atenção primária em saúde no Brasil e os instrumentos disponíveis para a assistência à saúde bucal e compara o número de instrumentais de acordo com as características organizacionais dos serviços de saúde e entre as macrorregiões. Das 23.251 equipes de saúde bucal (ESB) no Sistema Único de Saúde, 17.513 (75,3%) participaram deste estudo. Pesquisadores treinados observaram a estrutura dos serviços de saúde e determinaram a presença e a existência de uma quantidade suficiente de 36 instrumentais odontológicos. A pontuação de cada serviço de saúde bucal foi determinada pela soma do número de instrumentos dentários presentes em quantidade suficiente (0 a 36). As medidas de tendência central e de variabilidade desse escore foram comparadas com as características organizacionais dos serviços e de acordo com a macrorregião brasileira. Nenhum instrumental foi encontrado em todos os serviços avaliados. Os instrumentos básicos, cirúrgicos e restauradores foram os mais frequentemente encontrados. Os instrumentos periodontais, endodônticos e para realização de prótese exibiram as percentagens mais baixas. O número médio e mediano de instrumentos dentários foi maior para as equipes que operavam em mais turnos, aqueles com um técnico em saúde bucal e aqueles nas regiões Sul e Sudeste. Os serviços de saúde bucal estavam equipados com instrumentos básicos, cirúrgicos e restauradores. Os instrumentos indicados para diagnóstico periodontal, cuidados de emergência e reabilitação com próteses dentárias foram menos frequentemente encontrados nesses serviços. As piores condições de infra-estrutura existiam nos ESB com as piores formas de organização de cuidados e em regiões com maiores problemas sociais.

Two-stage technique in third molar autotransplantation: case report / Técnica de dois estágios no autotransplante de terceiro molar: relato de caso

ABSTRACT Tooth autotransplantation is an option for treating patients presenting early tooth loss. The teeth most commonly removed are the first molars, and their absence could lead to several oral health problems in patients. This transplant technique consists of the transposition and repositioning of a tooth from one area to another, in the same patient. Dental implants have high success rates, but tooth autotransplantation is less complex and less expensive, because the patient's own tooth is used. In the context of dental rehabilitation, tooth transplantation is focused on re-establishing masticatory function and esthetics. Success rates are variable, but in the majority of cases they exceed 80%. This article aims to report the case of a patient who underwent autotransplantation of the maxillary left third molar into the maxillary right first molar position. The surgical procedure was performed on two stages. After a 3-year clinical and radiographic follow-up period, a satisfactory result was achieved with the transplanted tooth presenting a healthy pulp and periodontal tissues, reestablishing the patient's function and esthetics.

RESUMO O transplante dentário autógeno (autotransplante dentário) é uma opção de tratamento para pacientes que perdem dentes precocemente. Os elementos mais comumente extraídos são os primeiros molares permanentes e a falta dos mesmos pode acarretar em diversos agravos para a saúde bucal do paciente. O autotransplante dentário consiste na transposição cirúrgica e reposicionamento de um elemento dentário, de um local da boca para outro, no mesmo indivíduo. O tratamento com implantes possui elevado índice de sucesso, mas o transplante apresenta maior praticidade e menor custo, uma vez que utiliza um órgão do próprio paciente. Assim, como a reabilitação protética, tem como função o restabelecimento da mastigação e estética. As taxas de sucesso são variáveis, mas em sua maioria ultrapassam os 80%. O presente trabalho relata o caso clínico de uma paciente submetida ao transplante do germe dental do elemento 28 para o alvéolo do elemento 16. O ato cirúrgico foi realizado com a técnica de dois estágios e após o acompanhamento clínico e radiográfico de três anos, obteve-se um resultado satisfatório e o elemento transplantado apresentou saúde pulpar e periodontal, restabelecendo a função e a estética à paciente.

Secondary care in oral health in small municipalities: a cross-sectional evaluation of demand x access / Atenção secundária em saúde bucal em municípios de pequeno porte: uma avaliação transversal da demanda x acesso

ABSTRACT Objective: To know the demand and access to specialized procedures in Oral Health in 10 municipalities in the region of Guanhães, Minas Gerais, Brazil, which do not have a Dental Specialty Center. Methods: Cross-sectional study was conducted with 30 dental surgeons of the Primary Care system. These dentists recorded all the patients who were treated from July to November 2016, and who were shown to be in need of being assigned to specialized procedures in oral health. The descriptive analysis was developed in the software SPSS for Windows version 18.0. The study was approved by the Research Ethics Committee of the Federal University of Minas Gerais (ruling 1.615.701). Results: 1085 patients assigned for specialized procedures in Oral Health were evaluated. The majority of these patients were women (56.6%), within an age-range from 13-34 years (51.9%). Among the specialties evaluated, 61% of the patients presented the need for endodontic treatment, with the most compromised tooth being the first permanent molar (33.2%). The outcomes were recorded for 435 (40.1%) patients. Among these, 19.8% of the procedures were performed in the health unit itself and in 45.5% extractions were performed. Conclusion: Limited access to specialized Oral Health procedures was verified. To enable the Oral Health National Policy to consider the specificities of such regions, it is suggested that the scope of action of the oral health teams in primary care is expanded, or that less expensive specialized services are created, so that the access to this level of oral health is assured to all referred patients.

RESUMO Objetivo: Conhecer a demanda e o acesso para procedimentos especializados em Saúde Bucal em 10 municípios da região de Guanhães, Minas Gerais, que não possuem Centro de Especialidades Odontológicas. Métodos: Estudo transversal realizado com 30 cirurgiões-dentistas da Atenção Primária que registraram todos os pacientes que foram atendidos no período de julho a novembro de 2016 que apresentassem necessidade de indicação para procedimentos especializados em saúde bucal. A análise descritiva foi desenvolvida no programa SPSS for Windows versão 18.0. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais (parecer 1.615.701). Resultados: Foram avaliados 1085 pacientes com indicação para procedimentos especializados em Saúde Bucal. A maioria era do sexo feminino (56,6%), com idade entre 13 e 34 anos (52,6%). Das especialidades avaliadas, 61% dos pacientes apresentaram necessidade de tratamento endodôntico, sendo que o dente mais acometido foi o primeiro molar permanente (47,2%). Os desfechos foram registrados para 435 (40,1%) pacientes. Nesses, 19,8% dos procedimentos foram realizados na própria unidade de saúde e 45,5% foram submetidos à exodontia. Conclusão: Verificou-se a limitação de acesso aos procedimentos especializados em Saúde Bucal. Para que a Política Nacional de Saúde Bucal possa contemplar especificidades de regiões como essa, sugere-se a ampliação do escopo de ação das equipes de saúde bucal na atenção primária ou da criação de serviços especializados de menor monta, a fim de garantir acesso a este nível em saúde bucal para todos os pacientes.

Mapping of adolescents with gingivitis and dental calculus / Mapeamento de adolescentes com gengivite e cálculo dental / Mapeo de adolescentes con gingivitis y cálculo dental

Objective: The aim of this study was to map the distribution of periodontal disease in adolescents in the Jequitinhonha Valley. Methods: We constructed maps with varying Community Periodontal Index (CPI). The cities were selected based on population size and performance of oral health services. The sampling plan was composed of 450 individuals between 15 and 19 years, randomly selected in number corresponding to the proportion of the adolescent population in each municipality. Results: Of the 450 adolescents examined were 16 (3.5%) code 0 (Healthy), 232 (51.5%) of the code 1 (bleeding), 38 (8.44%) code 2 (Calculus) and 164 (36.44%) code 6 (bleeding and calculus). The pattern of mosaic maps was kind and may indicate that the worst periodontal conditions of adolescents were distributed throughout the region. Conclusion: maps described the oral health status of adolescents and can provide information for planning oral health.

Objetivo: Este estudo foi mapear a distribuição da doença periodontal nos adolescentes do Vale do Jequitinhonha. Métodos: Foram construídos mapas com variáveis do Índice Periodontal Comunitário (IPC). Os municípios foram selecionados com base no porte populacional e no desempenho do serviço de saúde bucal. O plano amostral foi composto por 450 indivíduos entre 15 e 19 anos, selecionados aleatoriamente, em número correspondente à proporção da população adolescente de cada município. Resultados: Dos 450 adolescentes examinados foram 16 (3,5%) de código 0 (Saudável), 232 (51,5%) do código 1 (sangramento), 38 (8,44%) de código 2 (Calculus) e 164 (36,44%) de código 6 (sangramento e cálculo). O padrão dos mapas foi do tipo mosaico e pode indicar que as piores condições periodontais dos adolescentes estavam distribuídas por toda a região. Conclusão: Mapas descreveram a condição de saúde bucal de adolescentes e pode fornecer subsídios para o planejamento em saúde bucal.

Objetivo: Este estudio fue determinar la distribución de la enfermedad periodontal en adolescentes del Valle de Jequitinhonha. Métodos: Se construyeron mapas con diferentes Índice Periodontal Comunitario (IPC). Las ciudades fueron seleccionadas en base al tamaño de la población y el desempeño de los servicios de salud oral. El plan de muestreo estuvo compuesto por 450 personas entre 15 y 19 años, seleccionados al azar en el número correspondiente a la proporción de la población adolescente en cada municipio. Resultados: De los 450 adolescentes examinados fueron 16 (3,5%) de código 0 (sano), 232 (51,5%) del código 1 (sangrado), 38 (8,44%) Código 2 (cálculo) y 164 (36,44%) de código 6 (sangrado y cálculo). El patrón de mapas mosaico era amable y puede indicar que las peores condiciones periodontales de los adolescentes se distribuyeron en toda la región. Conclusión: Los mapas describen el estado de salud bucal de los adolescentes y pueden proporcionar información para la planificación de la salud oral.

Hospital Dental Treatment for Special Health Care Needs Patients in Minas Gerais state, Brazil: A Cluster Analysis

Objective: To describe and group some demographic and healthcare characteristics of hospital dental care for the special health care needs population. Material and Methods: Cross-sectional census survey with a total of 1,063 visits with special health care need patients under general anesthesia or sedation at the Brazilian Health System Minas Gerais, Brazil, over 12 months. Clinical diagnosis was divided into "mental and behavioral disorders and diseases of the nervous system" and "others". Age group, gender, clinical diagnosis and care by a general dentist were submitted to descriptive and multivariate cluster analysis. The analysis was performed using the software SPSS version 19.0. Results: Cluster 1 (N=173) had no ICD codes for nervous system (NS) diseases and mental and behavioral disorders. Clusters 2 (N=564) and 3 (N=326) are quite similar except for gender distribution. Cluster 1 was 3.5 times more frequent among non-host cities than HER host cities. Dental treatment was mostly performed on males diagnosed with mental and behavioral disorders and diseases of the NS who were over the age of 25 years and were seen by general dentists. The clusters were distributed unevenly between EHR host and non-host cities. Conclusion: Non-host performed more frequently treatment for patients with no mental and behavioral disorders and diseases of the NS than EHR host cities.

[The relationship between gingival condition and socio-demographic factors of adolescents living in a Brazilian region]. / Relação entre condição gengival e fatores sociodemográficos de adolescentes residentes em uma região brasileira.

The scope of this study is to correlate the gingival condition and sociodemographic status of adolescents living in an economically disadvantaged Brazilian region. The survey was conducted with a random sample of 450 adolescents in 13 cities selected in the Jequitinhonha Valley (State of Minas Gerais). The gingival condition was evaluated using a calibrated examiner (Kappa ≥ 0.85). The oral exam was based on the Community Periodontal Index (CPI). The frequencies of individuals were calculated and sextants subsequently assessed using Multiple Correspondence Analysis (ANACOR) to reveal the relationship between CPI and sociodemographic characteristics. The results showed that: 16 (3.6%) were healthy; 235 (52.2%) had gingival bleeding; 36 (8%) had dental calculus and 163 (36.2%) had both bleeding and calculus. ANACOR identified two groups with similarities in relation to periodontal disease. Group one featured 19-year-olds with healthy CPI who work and have higher family income. Group two included 15- and 16-year-olds of both sexes with CPI and gingival bleeding in elementary school with lower family income, who declared themselves to be of mixed or Afro-descendant race. The presence of gingivitis was related to the socioeconomic and demographic characteristics of adolescents in the region.

Relação entre condição gengival e fatores sociodemográficos de adolescentes residentes em uma região brasileira / The relationship between gingival condition and socio-demographic factors of adolescents living in a Brazilian region

O objetivo deste artigo é relacionar as condições gengival e socioeconômica e distribuição demográfica de adolescentes residentes em uma região desfavorecida brasileira. O estudo transversal foi realizado com amostra probabilística de 450 adolescentes (15-19 anos) em 13 municípios sorteados no Vale do Jequitinhonha (MG). A condição gengival foi avaliada por um examinador calibrado (Kappa ≥ 0,85) e baseado Índice Periodontal Comunitário (CPI). Foram calculadas as frequências para indivíduos e sextantes com posterior Análise de Correspondência Múltipla (Anacor) que explorou relações entre o CPI e as características sociodemográficas. Como resultados: 16 (3,6%) apresentaram-se sem alterações gengivais, 235 (52,2%) com sangramento, 36 (8,0%) com cálculo dental e 163 (36,2%) com sangramento e cálculo. A Anacor identificou dois grupos que guardavam semelhanças entre si em relação à doença periodontal. O grupo 1 reuniu os adolescentes com CPI sadio, 19 anos de idade, que trabalham e têm maior renda familiar. No grupo de CPI com sangramento, tem-se os adolescentes com 15 e 16 anos de idade, de ambos os sexos, cursando o ensino fundamental, menor renda familiar e que se autodeclararam pardos ou negros. A gengivite foi relacionada às condições socioeconômicas e demográficas de adolescentes da região.

The scope of this study is to correlate the gingival condition and sociodemographic status of adolescents living in an economically disadvantaged Brazilian region. The survey was conducted with a random sample of 450 adolescents in 13 cities selected in the Jequitinhonha Valley (State of Minas Gerais). The gingival condition was evaluated using a calibrated examiner (Kappa ≥ 0.85). The oral exam was based on the Community Periodontal Index (CPI). The frequencies of individuals were calculated and sextants subsequently assessed using Multiple Correspondence Analysis (ANACOR) to reveal the relationship between CPI and sociodemographic characteristics. The results showed that: 16 (3.6%) were healthy; 235 (52.2%) had gingival bleeding; 36 (8%) had dental calculus and 163 (36.2%) had both bleeding and calculus. ANACOR identified two groups with similarities in relation to periodontal disease. Group one featured 19-year-olds with healthy CPI who work and have higher family income. Group two included 15- and 16-year-olds of both sexes with CPI and gingival bleeding in elementary school with lower family income, who declared themselves to be of mixed or Afro-descendant race. The presence of gingivitis was related to the socioeconomic and demographic characteristics of adolescents in the region.

Availability of hospital dental care services under sedation or general anesthesia for individuals with special needs in the Unified Health System for the State of Minas Gerais (SUS-MG), Brazil.

This study identified the demographic characteristics of individuals and dental treatment care under sedation/general anesthesia in a hospital environment in the Unified Health System in the State of Minas Gerais (SUS-MG). All Hospitalization Authorizations (AIHs) for Dental Treatment for Patients with Special Needs procedures were evaluated between July 2011 and June 2012. Demographic and health care variables for treatment were also assessed. Hospitalization rates per 10,000 inhabitants, and health care coverage provided in the state of Minas Gerais and in each of the Broader Health Regions were calculated. Descriptive analysis of data was carried out by calculating the central trend and variability frequency and measurements. All 1,063 AIHs paid during the study period were evaluated, which is equivalent to a rate of 0.54 hospitalizations per 10,000 individuals. The majority of the patients were adult, male, diagnosed with mental or behavioral disorders and resident in 27.7% of the municipalities in Minas Gerais. The procedures were performed in 39 municipalities and the care coverage was equal to 1.58%. The study reveals a classic demographic and clinical profile of patient attendance. Difficulties in establishing a network of dental care were identified.

Utilização dos serviços de atendimento odontológico hospitalar sob sedação e/ou anestesia geral por pessoas com necessidades especiais no SUS-MG, Brasil / Availability of hospital dental care services under sedation or general anesthesia for individuals with special needs in the Unified Health System for the State of Minas Gerais (SUS-MG), Brazil

O presente estudo identificou as características demográficas dos indivíduos e assistenciais do tratamento odontológico sob sedação e/ou anestesia geral em ambiente hospitalar no SUS-MG. Foram avaliadas todas as Autorizações de Internações Hospitalares (AIH) para o procedimento Tratamento Odontológico para Pacientes com Necessidades Especiais, de julho de 2011 a junho de 2012. Foram mensuradas variáveis demográficas e assistenciais dos atendimentos. Foram calculadas as taxas de internações por 10.000 habitantes e a cobertura assistencial realizada no estado de Minas Gerais e em cada uma das Regiões Ampliadas de Saúde. A análise descritiva das variáveis foi feita por meio de cálculo da frequência e medidas de tendência central e variabilidade. Foram avaliadas todas as 1.063 AIH pagas no período estudado, que representaram uma taxa de 0,54 internações por 10.000 habitantes. A maioria dos indivíduos era adulta, do sexo masculino, com diagnóstico de transtornos mentais ou comportamentais e residente em 27,7% dos municípios de Minas Gerais. Os procedimentos foram realizados em 39 municípios e a cobertura assistencial foi igual a 1,58%. O estudo revelou um perfil clássico do paciente atendido. Dificuldades em se estabelecer uma rede de atenção à saúde bucal foram identificadas.

This study identified the demographic characteristics of individuals and dental treatment care under sedation/general anesthesia in a hospital environment in the Unified Health System in the State of Minas Gerais (SUS-MG). All Hospitalization Authorizations (AIHs) for Dental Treatment for Patients with Special Needs procedures were evaluated between July 2011 and June 2012. Demographic and health care variables for treatment were also assessed. Hospitalization rates per 10,000 inhabitants, and health care coverage provided in the state of Minas Gerais and in each of the Broader Health Regions were calculated. Descriptive analysis of data was carried out by calculating the central trend and variability frequency and measurements. All 1,063 AIHs paid during the study period were evaluated, which is equivalent to a rate of 0.54 hospitalizations per 10,000 individuals. The majority of the patients were adult, male, diagnosed with mental or behavioral disorders and resident in 27.7% of the municipalities in Minas Gerais. The procedures were performed in 39 municipalities and the care coverage was equal to 1.58%. The study reveals a classic demographic and clinical profile of patient attendance. Difficulties in establishing a network of dental care were identified.

Condição gengival de adolescentes residentes no vale do Jequitinhonha, Minas Gerais / Gingival condition of adolescents in Vale do Jequitinhonha, Minas Gerais, Brazil

Objetivo: Este estudo teve por objetivo descrever a condição gengival de adolescentes de 15 a 19 anos no Vale do Jequitinhonha, Minas Gerais. Materiais e Métodos: O estudo foi realizado com amostra calculadade 450 indivíduos em treze municípios selecionados de forma aleatória simples, após estratificação dos mesmos de acordo com porte populacional e o desempenho do serviço de saúde bucal municipal. A avaliação da condição gengival foi analisada por um único examinador calibrado (Kappa≥0,85). O instrumento da análise utilizado foi um questionário com variáveis sociodemográficas e hábitos, respondido individualmente por cada adolescente. Para os dados clínicos, utilizou-se-se a codificação 0, 1 e 2 do Índice Periodontal Comunitário (CPI) realizado no local de residência do adolescente, com utilização de sonda periodontal tipo OMS. A avaliação foi obtida classificando: ausência de alteração gengival; apresentação de sangramento gengival à sondagem; presença de cálculo dentário; e presença de cálculo dentário e sangramento gengival. Resultados: Dos 450 adolescentes examinados, 16 (3,55%) apresentaram-se sem alterações gengivais, 235 (52,22%) com sangramento, 36 (8,00%) com cálculo dentário e 163 (36,22%) com sangramento e cálculo. De um total de 2699 sextantes, 791 (29,30%) estavam hígidos, 1392 (51,56%) com sangramento, 94 (3,48%) com cálculo e 422 (15,63%) com sangramento e cálculo e um sextante estava perdido (0,03%). Conclusão: Uma importante proporção de adolescentes apresenta-se com sangramento e cálculo.

[Socioeconomic indicators and oral health services in an underprivileged area of Brazil]. / Indicadores socioeconômicos e serviços odontológicos em uma região brasileira desfavorecida.

OBJECTIVE: To evaluate the association between the proportion of tooth extractions, socioeconomic indicators, and the availability of oral health services in an underprivileged area of Brazil. METHODS: An ecological study was carried out in 52 municipalities in the state of Minas Gerais, Brazil. The socioeconomic indicators employed were criteria for health care resources allocation, municipal human development index, Theil index, Gini coefficient, and sanitation conditions. Concerning the availability of oral health services, the following were considered: number of inhabitants, number of dental surgeons living in the city, number of dentists working in the public services, and number of municipal oral health care teams. The utilization of oral health services was evaluated using the indicators recommended by the Health Ministry's Basic Care Package (Pacto da Atencão Básica in Portuguese) and the number of procedures carried out in the primary care setting. The 17 variables assessed were grouped into factorial components, which were then analyzed in terms of their relationship with the dependent variable, tooth extractions. RESULTS: The following six components explained 73.5% of the overall variance: socioeconomic conditions, social inequality, Basic Care Package indicators, number of procedures carried out, ratio of dentists to inhabitants, and coverage of the Family Health Strategy. Inequalities in income distribution (P = 0.031) and coverage by the Family Health Strategy (P = 0.015) contributed significantly to explain the difference in the proportion of tooth extractions in the different municipalities under study. CONCLUSIONS: The dental loss observed in the region is largely explained by socioeconomic factors and aspects related to the organization of oral health services.

Indicadores socioeconômicos e serviços odontológicos em uma região brasileira desfavorecida / Socioeconomic indicators and oral health services in an underprivileged area of Brazil

OBJETIVO: Avaliar a associação entre proporção de exodontias, indicadores socioeconômicos e oferta de serviços odontológicos em uma região desfavorecida do Brasil. MÉTODOS: Um estudo ecológico foi realizado em 52 municípios do Estado de Minas Gerais, Brasil. Os indicadores socioeconômicos utilizados foram os critérios de alocação de recursos financeiros destinados à saúde, os índices de desenvolvimento humano municipal, de Theil e de Gini e as condições de saneamento. Em relação à oferta de serviços de saúde bucal, foram considerados o número de habitantes, o número de cirurgiões-dentistas residentes no município, o número de dentistas que trabalhavam no serviço público e o número de equipes de saúde bucal. A utilização de serviços foi avaliada pelos indicadores de saúde bucal preconizados pelo Pacto da Atenção Básica e pelo número de procedimentos realizados na atenção primária. As 17 variáveis avaliadas foram agrupadas em componentes. Analisou-se a relação entre esses componentes fatoriais e a variável dependente, proporção de exodontias. RESULTADOS: As variáveis foram agrupadas em seis componentes (condições socioeconômicas, desigualdades sociais, indicadores do Pacto da Atenção Básica, número de procedimentos realizados, razão dentistas:população, cobertura da Estratégia Saúde da Família) que explicaram, no conjunto, 73,5% da variância total. As desigualdades na distribuição de renda (P = 0,031) e a cobertura da Estratégia Saúde da Família (P = 0,015) tiveram significativamente maior peso para explicar a diferença na proporção de exodontias realizadas nos municípios estudados. CONCLUSÕES: Os fatores socioeconômicos e de organização dos serviços de saúde bucal explicam grande parte da mutilação dentária nessa região.

OBJECTIVE: To evaluate the association between the proportion of tooth extractions, socioeconomic indicators, and the availability of oral health services in an underprivileged area of Brazil. METHODS: An ecological study was carried out in 52 municipalities in the state of Minas Gerais, Brazil. The socioeconomic indicators employed were criteria for health care resources allocation, municipal human development index, Theil index, Gini coefficient, and sanitation conditions. Concerning the availability of oral health services, the following were considered: number of inhabitants, number of dental surgeons living in the city, number of dentists working in the public services, and number of municipal oral health care teams. The utilization of oral health services was evaluated using the indicators recommended by the Health Ministry's Basic Care Package (Pacto da Atencão Básica in Portuguese) and the number of procedures carried out in the primary care setting. The 17 variables assessed were grouped into factorial components, which were then analyzed in terms of their relationship with the dependent variable, tooth extractions. RESULTS: The following six components explained 73.5% of the overall variance: socioeconomic conditions, social inequality, Basic Care Package indicators, number of procedures carried out, ratio of dentists to inhabitants, and coverage of the Family Health Strategy. Inequalities in income distribution (P = 0.031) and coverage by the Family Health Strategy (P = 0.015) contributed significantly to explain the difference in the proportion of tooth extractions in the different municipalities under study. CONCLUSIONS: The dental loss observed in the region is largely explained by socioeconomic factors and aspects related to the organization of oral health services.

Inserção do aluno de odontologia no SUS: contribuições do Pró-Saúde / Participation by dentistry students in the Unified National Health Service: contributions from the Educational Program for Health Work

O objetivo deste trabalho é descrever a experiência da disciplina Ciências Sociais Aplicadas à Saúde (CSAS) da Faculdade de Odontologia da Universidade Federal de Minas Gerais (FO-UFMG). Em resposta às recomendações das Diretrizes Curriculares Nacionais para os cursos de graduação em Odontologia e do Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde), desde 2004, a FO-UFMG tem-se mobilizado para mudar seu currí­culo, dando atenção especial à diversificação dos cenários de aprendizagem. Em 2007, a disciplina de CSAS foi reformulada, permitindo a inserção dos discentes no Sistema Único de Saúde (SUS) no iní­cio de sua formação profissional, quando a realidade e a prática do SUS são os objetos de ensino. Esse movimento reforçou as expectativas de que essa inserção é viável. Espera-se que as mudanças na disciplina funcionem como um projeto piloto, subsidiando outras iniciativas que destinem a uma maior aproximação dos estudantes com a prática profissional, e que sirva de parâmetro na organização e planejamento de outros conteúdos vinculados à saúde coletiva a serem incluí­dos na formação profissional.

This study aims to describe the experience in the course on Social Sciences Applied to Health at the Dentistry School of the Federal University in Minas Gerais (FO-UFMG). In response to the recommendations in the National Curriculum guidelines for undergraduate dentistry courses and the National Program for the Reorientation of Professional Training in Health (Pró-Saúde), since 2004 the FO-UFMG has taken steps to change its curri­culum, with special attention on the diversification of learning settings. In 2007, the course on Social Sciences Applied to Health was reformatted, allowing participation by students in the Unified National Health System since the beginning of their professional training, whereby the reality and practices of the National Health System become objects of learning. This movement reinforced the expectations that such participation is feasible. The changes in the course are expected to serve as a pilot project, backing initiatives towards closer ties between students and professional practice, serving as a benchmark for the organization and planning of other public health course contents to be included in the professional training.