Budgetary Impact of Oral Rehabilitation With Complete Dentures: An Economical Evaluation From São Paulo State, Brazil.

OBJECTIVE: To develop a budgetary impact analysis regarding the possibility of offering complete upper and lower dentures to an eligible population of elderly people (above 65 years) in the São Paulo state, Brazil. METHODS: The proportion of eligible population was calculated by assessing the prevalence of edentulous (upper and lower arch) and by defining the eligible group (public health system users). The budgetary impact analysis was designed under the following scenario: 5-year time horizon (2018-2022), prospect of municipal expenses with prostheses, and additional progressive incorporation of technology (upper and lower dentures) at an annual rate of 10%, 15%, 20%, 25%, and 30%. Sensibility analysis was performed in 3 different situations (reference, more pessimistic, and more optimistic) based on the calculation of spending through assessed demand and epidemiological demand. RESULTS: The municipal cost for each denture, already discounted the value transferred by the union for this procedure, was R$50.97. The incremental impact on the budget measured by the epidemiological demand relative to assessed demand was approximately R$59 141 510 over 5 years, meaning an impact of 0.08% (0.01% more optimistic; 0.13% more pessimistic) of the "medium and high complexity care" budget and 0.09% (0.03%-0.14%) of the primary care budget. CONCLUSION: The budgetary impact of increasing the oral rehabilitation with complete dentures for elderly population in the São Paulo state is low relative to the expenses with primary or specialized care budgets. In addition, incorporation of denture rehabilitation would be feasible, according to the financial availability and priorities of each municipality.

Próteses totais mucossuportadas ofertadas na atenção primária à saúde em Belo Horizonte, MG: avaliação após 5 anos de uso / Dentures mucus-supported offered in primary health care in Belo Horizonte, MG: evaluation after 5 years of use

A prótese total (PT) é o tratamento reabilitador mais utilizado em pacientes edêntulos e pode resgatar a estética, a função mastigatória e a fonação. O levantamento das condições de saúde bucal da população brasileira (2011) revelou que 69% da população adulta e quase 99% dos idosos usavam ou necessitavam de algum tipo de prótese dentária. A inclusão da reabilitação protética no âmbito da Atenção Primária em Saúde é uma das diretrizes da Política Nacional de Saúde Bucal (2004). Esse serviço se iniciou em Belo Horizonte em julho de 2010 com a oferta de próteses totais (PTs) e próteses parciais removíveis (PPR) de acrílico. O objetivo desse estudo foi avaliar a associação entre o uso das próteses totais mucossuportadas ofertadas na Atenção Primária à Saúde após um e cinco anos de inserção com a qualidade técnica dessas próteses e a satisfação dos usuários com as mesmas). Foi realizado um estudo de seguimento com amostra de 233 usuários, aleatoriamente, selecionada do universo de 572 usuários que receberam o par de próteses totais em 2011. Avaliou-se o uso de prótese total superior e inferior, que resultou na variável dependente dicotômica: não uso; uso do par ou de uma das próteses. A qualidade técnica foi avaliada quanto a arranjo dos dentes anteriores, espaço funcional livre, estabilidade, retenção e extensão da prótese mandibular, oclusão estática e dinâmica. A integridade das próteses considerou presença de fratura da base e bordos irregulares. A avaliação da satisfação com relação a dor, retenção, estabilidade, conforto, mastigação, fala e aparência resultou em um escore de 0 a 100, que foi categorizado adotando-se o ponto de corte 70 em: insatisfeito ou muito satisfeito/satisfeito. Foram avaliadas as seguintes co-variáveis: idade, sexo, situação conjugal, anos de estudo e renda familiar, uso pregresso de próteses totais, tempo da perda de dentes superiores e frequência de retorno ao cirurgião-dentista posterior à entrega das próteses. As associações foram testadas por análise de regressão logística, o efeito das variáveis no uso de prótese total ao longo dos períodos propostos foi estimado por modelos de regressão logística com efeitos aleatórios no intercepto. A coleta dos dados por meio de entrevista e exame da cavidade bucal e das próteses foi realizada entre novembro de 2012 a janeiro de 2013 e de julho a outubro de 2016. As examinadoras foram previamente calibradas e a concordância intra e interexaminadoras foi calculada por Kappa ponderado e os coeficientes foram superiores a 0,81. A taxa de participação foi de 97,8% (228) em um ano e de 50% (114) em cinco anos pós a instalação das próteses. Não houve diferença estatisticamente significativa entre respondentes e não respondentes com relação a sexo, idade, escolarização, anos de estudo, frequência de retorno ao cirurgião-dentista e satisfação com a prótese. Entretanto, a qualidade técnica da prótese nos critérios estabilidade, oclusão estática e dinâmica foi menor entre os não respondentes. Após um ano, 64,9% usavam o par de próteses, 14% usavam uma das próteses e 21,1% não usavam. Já em cinco anos, 64,1% usavam o par de próteses, 14,9% usavam pelo menos uma das próteses e 21,0% não usavam. Observou-se que entre os indivíduos que usavam o par de próteses em cinco anos, 86,3% já usavam o par em um ano e entre os que não usavam 37,5% deixaram de usá-las após o primeiro ano. Após cinco anos, em relação à qualidade técnica das próteses, cerca de 70% foram consideradas adequadas para arranjo dos dentes anteriores, espaço funcional livre, estabilidade da prótese mandibular, oclusão estática e oclusão dinâmica. Mais de 80% das próteses mandibulares apresentaram problemas de retenção e extensão da borda. A quase totalidade das próteses não apresentava problemas de integridade. Quanto à satisfação com as próteses, 57,02% dos usuários estavam muito satisfeitos/satisfeitos. Os fatores de satisfação melhores avaliados foram estética, fala e conforto. A retenção da prótese total inferior gerou a maior insatisfação. Foi encontrada associação entre uso de próteses totais após um ano de inserção em indivíduos cujas próteses apresentavam estabilidade, espaço funcional livre entre 1 e 4 mm e estavam satisfeitos/muito satisfeitos. Após cinco anos de inserção, o uso das próteses totais foi associado à estabilidade da prótese mandibular e à satisfação. As próteses ofertadas satisfazem a população assistida e a maioria apresenta qualidade técnica e integridade. Maior uso após cinco anos de inserção foi observado entre os usuários satisfeitos e com próteses mandibulares estáveis, esse uso foi maior entre os indivíduos que já usavam após um ano de inserção, indicando maior abandono no primeiro ano. Protocolos de acompanhamento dos pacientes após a entrega das próteses totais devem ser implantados no âmbito dos serviços públicos de saúde para favorecer a adesão e sucesso do tratamento reabilitador

The total prosthesis (TP) is the most used rehabilitating treatment in edentulous patients and it may rescue the aesthetics, the masticatory function and the phonation. The survey of the oral health conditions of the Brazilian population (2011) revealed that 69% of the adult population and almost 99% of the elderly used or needed some sort of dental prosthesis. The inclusion of the prosthetic rehabilitation in the scope of Basic Assistance in Health is one of the guidelines of the National Policy in Oral Health (2004). This service was started in Belo Horizonte in July 2010 with the offer of total prosthesis (TPs) and partial removable prosthesis (PRP) of acrylic. The aim of this study was to evaluate the association between the uses of the total prosthesis mucus-supported offered in the Primary Care in Health after one and five years of the insertion with the technical quality of these prostheses and the satisfaction of the users towards them. A follow-up study was carried out with a sample of 233 users at random, selected within a universe of 572 users who had received the pair of full prosthesis in 2011. The use of the total prosthesis both inferior and superior was evaluated, which resulted in the dichotomous dependent variable: no use; use of the pair or of one of the prosthesis. The technical quality was evaluated with regards to the arrangement of the anterior teeth, free functional space, stability, retention and extension of the mandibular prosthesis, static and dynamic occlusion. The integrity of the prosthesis considered the presence of fracture of the basis and irregular edges. The evaluation of the satisfaction concerning the pain, retention, stability, comfort, mastication, speech and appearance resulted in a score ranging from 0 to 100, which was categorized adopting the cut-off point of 70 to dissatisfied or very satisfied/satisfied. The following co-variables were assessed: age, gender, marital status, years of schooling and family income, previous use of total prosthesis, time for upper teeth loss and frequency of visits to the dental surgeon after the placement of the prosthesis. The associations were tested through a logical regression analysis; the effect of the variables in the use of total prosthesis along the proposed periods was estimated via logistic regression models with random effects in the intercept. The data collection through interviews and examination of the oral cavity and the prosthesis was carried out between November 2012 to January 2013 and from July to October 2016. The examiners were previously calibrated and the agreement intra and inter-examiners was calculated using pondered Kappa and the coefficients were superior to 0,81. The participation rate was 97,8% (228) in one year and 50% (114) in five years after the placement of the prosthesis. There was no statistically significant difference between the responsive and the non-responsive concerning gender, age, schooling, frequency of visits to the dental surgeon and satisfaction towards the prosthesis. However, the technical quality of the prosthesis within the criteria of stability, static and dynamic occlusions was lower among the non-responsive. After one year, 64,9% used the pair of prosthesis, 14% used one of the prosthesis and 21,1% did not use any. In five years, 64,1% used the pair of prosthesis, 14,9% used at least one of the prosthesis and 21,0% did not use any. It was observed that among the subjects who used the pair of prosthesis in five years, 86,3% already used the pair in one year and among those who did not use them 37,5% abandoned their use after the first year. After five years, regarding the technical quality of the prosthesis, around 70% were considered adequate for the arrangement of the anterior teeth, free functional space, and mandibular prosthesis stability, static and dynamic occlusion. More than 80% of the mandibular prosthesis presented retention problems and ridge extension. The almost full totality of the prosthesis did not present integrity problems. Concerning the satisfaction towards the prosthesis, 57,02% of the users were very satisfied/satisfied. The satisfaction factors better evaluated were aesthetics, speech and comfort. The inferior full prosthesis retention resulted in the higher level of dissatisfaction. Associations between the uses of full prosthesis were found after one year of placement in subjects whose prosthesis presented stability, free functional space ranging between 1 and 4 mm and were satisfied/very satisfied. After five years of placement, the use of full prosthesis was associated to the stability of the mandibular prosthesis and satisfaction. The offered prosthesis satisfies the assisted population and the majority presents technical quality and integrity. A greater use after five years of placement was observed among the satisfied users and those who had stable mandibular prosthesis; this use was higher among the subjects who already used that one year after the placement, indicating a greater rate of abandonment in the first year. Follow-up protocols of the patients after the placement of the full prosthesis must be implemented in the scope of public health services to favor the adhesion and success of the rehabilitating treatment

Influence of oral health condition on swallowing and oral intake level for patients affected by chronic stroke.

BACKGROUND: According to the literature, the occurrence of dysphagia is high in cases of stroke, and its severity can be enhanced by loss of teeth and the use of poorly fitting prostheses. OBJECTIVE: To verify that the status of oral health influences the level of oral intake and the degree of swallowing dysfunction in elderly patients with stroke in chronic phase. METHODS: Thirty elderly individuals affected by stroke in chronic phase participated. All subjects underwent assessment of their oral condition, with classification from the Functional Oral Intake Scale (FOIS) and nasoendoscopic swallowing assessment to classify the degree of dysphagia. The statistical analysis examined a heterogeneous group (HG, n=30) and two groups designated by the affected body part, right (RHG, n=8) and left (LHG, n=11), excluding totally dentate or edentulous individuals without rehabilitation with more than one episode of stroke. RESULTS: There was a negative correlation between the need for replacement prostheses and the FOIS scale for the HG (P=0.02) and RHG (P=0.01). Differences in FOIS between types of prostheses of the upper dental arch in the LHG (P=0.01) and lower dental arch in the RHG (P=0.04). A negative correlation was found between the number of teeth present and the degree of dysfunction in swallowing liquid in the LHG (P=0.05). There were differences in the performance in swallowing solids between individuals without prosthesis and those with partial prosthesis in the inferior dental arch (P=0.04) for the HG. CONCLUSION: The need for replacement prostheses, type of prostheses, and the number of teeth of elderly patients poststroke in chronic phase showed an association with the level of oral intake and the degree of oropharyngeal dysphagia.

Cirugía de alargamiento coronal y toma de impresión definitiva en la misma cita: una alternativa en casos especiales. Reporte de veinte casos / Crown lengthening surgery and final impression during the same appointment: an alternative for special cases. Series of twenty cases

Propósito: Describir una serie de casos en los que, por diferentes motivos, se debió realizarcirugía de alargamiento coronal, preparación dental y toma de impresión definitiva en unacita en dientes pilares de rehabilitación con prótesis fija. Métodos: Se reportan veinte casosde pacientes que requirieron tratamiento de rehabilitación definitiva en un número corto decitas por motivos de discapacidad, dificultad en la apertura bucal, poco tiempo en la ciudad,enfermedad sistémica o aprehensión. Dichos pacientes se sometieron a cirugía de alargamientocoronal, preparación dental y toma de impresión definitiva en zonas no estéticas enuna sola cita. Cuando fue requerido, hubo tratamiento previo de endodoncia y elaboraciónde postes. Resultados: No hubo complicaciones posquirúrgicas diferentes a las de todacirugía periodontal, como inflamación, dolor o sangrado, entre los veinte casos tratados.Conclusión: No se presentaron complicaciones en ninguno de los casos tratados. Se proponeesta conducta clínica en casos en los cuales esté indicada una cirugía de alargamientocoronal, preparación dental y toma de impresión definitiva en la misma cita...

Purpose: To describe a series of cases that, for different reasons, required crown lengthening surgery, dental preparation, and definitive dental impression performed in thesame appointment on pillar teeth for fixed dental prosthesis. Methods: This study reports a series of 20 patients who required definitive rehabilitation treatment in a small numberof appointments due to disability, mouth opening shortness, short stay in town, medicalcondition, or apprehensiveness. Patients underwent crown lengthening surgery, dental preparation,and definitive dental impression in non-aesthetic areas in the same appointment.When it was necessary, root canal and restoration with posts were carried out. Results:There were not postsurgical complications other than the usual localized periodontal inflammation,pain, and bleeding. Conclusion: There were no complications in the treatedcases. This clinical approach is recommended in cases where crown lengthening surgery,dental preparation and definite dental impressions in the same appointment are indicated...

[The stomatologic status of people of elderly and senile age].

This article presents the data of epidemiological inspection of 1000 persons of average, elderly and senile age. Prevalence and intensity of a current of the basic stomatologic diseases (caries, pathology of a paradont and a mucous membrane of an oral cavity, a temporal-mandibular joint and chewing muscles) have been studied. Indicators of need of people of various age groups in tooth prosthetics are established. Level of rendering the stomatologic help is defined to be insufficient in groups of people of elderly and senile age. Recommendations aimed at improvement of stomatologic help to people of elderly and senile age are made.

Perfil epidemiológico do uso e necessidade de prótese e dealterações de tecidos moles bucais em idosos de uma comunidade de Itajaí - SC / Epidemiology of the senior citizen's use and need for prostheses and alterations of oral soft tissues in a city in the south of Brazil

Objetivo: estimar a prevalência do uso e necessidade de próteses e alterações de mucosa bucal em idosos de uma comunidade do município de Itajaí (SC).Metodologia: participaram do estudo 196 pessoas com 60 anos de idade ou mais pertencentes ao territóriocoberto por uma equipe do Programa da Saúde da Família do município de Itajaí. Foi realizado exame clínico bucal eutilizou-se o formulário da Organização Mundial de Saúde para levantamentos epidemiológicos, sendo investigado,dentre outras variáveis, o uso e necessidade de prótese e as alterações de mucosa bucal. Para o tratamento dessas informações foi utilizado o programa estatístico Stata 9, sendo os dados apresentados por meio de estatística descritiva (distribuições de freqüências e médias). Resultados: observou-se que 74,0% da populaçãousavam algum tipo de prótese dentária superior e 42,9% inferior. Ainda assim, foi constatado alto percentual denecessidade de próteses (63,3% arco superior; 82,1% arco inferior) para esta população. Adicionalmente foiobservada alta prevalência de alterações da mucosa bucal (43,4%) entre os idosos. Conclusões: a severidade do quadro epidemiológicoobservado nesta população idosa mostra a necessidade premente de uma política concreta de ações preventivas, educativas, curativas e de reabilitação odontológica especificamente direcionadas para este estrato populacional.

Objective: to estimate the prevalence of the senior citizen’s use and need of prosthesis and mouth mucosaalterations in a community in the city of Itajai (SC). Methodology: there were 196 participants, aged 60 and over and residing in the area covered by the teamfrom Programa da Saúde da Família [Family Health Care Program] in the city of Itajaí. A clinical examination wasperformed using the World Health Organization’s form for epidemiological surveys, to investigate the variablesof the use and need for prosthesis and alterations of mouth mucosa. Stata 9.0 was used to handle the informationand calculate the averages and proportions of the variables in the group studied. Results: a large contingent of the elderly wore some sort of dental prosthesis (74,1%), nonetheless, a highpercentage of this population needing prosthesis (63,3% upper arch, 82,1% lower arch) was confirmed. Additionally, a high prevalence of alterations in mouthmucosa (43,4%) in this group of senior citizens was observed. Conclusions: the severity observed in this elderlypopulation’s epidemiological state, shows the pressing need of a concrete policy for preventative, educational,curative, and rehabilitating dental measures aimed specifically at this stratum of society in an unequivocalway.

An evaluation of the San Francisco Department of Human Services Welfare Dental Program.

OBJECTIVE: To evaluate the welfare-to-work San Francisco Personal Assisted Employment Services (PAES) Dental Program. METHODS: A cohort of 377 study participants in the novel PAES Dental Program were followed through their baseline examination, rehabilitative dental treatment, follow-up exam, and completion of patient satisfaction survey. A framework of structure, process, and outcome measures was used to evaluate the success of the Dental Program. Chi square test, logistic regression, and paired t-test were used to analyze the levels of participation and satisfaction in the program. RESULTS: Of the 377 study participants, 265 (70%) completed their rehabilitative dental treatment. Those who completed their dental treatment had more missing teeth and fewer decayed teeth at baseline than those who did not complete their treatment. High levels of patient satisfaction were reported for the Dental Program. Ninety-seven percent of 173 respondents felt that they had been treated with respect, 92% were satisfied with the scheduling of their appointments, 91% were satisfied with their Dental Program experience, and 90% felt that their chief complaint had been solved. CONCLUSION: The PAES Dental Program provided high levels of patient satisfaction for process and outcome measures.

Prosthetic treatment need in a representative German sample.

Regarding declining resources epidemiological data on needs for oral rehabilitation are required. Within the framework of an oral health survey a non-stratified two-stage random sample was taken to represent the over 14-year-old population of Saxony/Germany. The participation rate was 55%. Normative need was determined by dental assessment and guidelines developed in a consensus process, subjective prosthetic treatment need by self-complete questionnaire. About 97% of the realized sample could be planned within the guidelines. About 81% had normative prosthetic treatment need. Compared with the rate of normative need the rate of subjective need (13%) was considerably lower (chi(2) P < 0;01). Different predictive parameters of subjective need were identified by logistic regression. Besides other factors subjective need was associated with giving dentist's recommendation as significant reason for prosthetic restorations [odds ratio (OR)=5;43], not believing that the own teeth were all right (OR=0;17), and the existence of prosthetic restorations (OR=3;87 for fixed restorations; OR=4;05 for removable dentures). The guidelines proved their suitability to assess normative prosthetic treatment need in oral health surveys. Further research is necessary to find adequate options for including patients' preferences in an adequate need definition.

Conductas y factores determinantes en salud oral de los adolescentes / Decisive factors and behavior in adolescent oral health

Con el propósito de contribuir al conocimiento sobre las conductas en salud oral de los adolescentes y los factores que las determinan, se aplicó una encuesta semiestructurada de 53 contenidos a 381 escolares de ambos sexos de 7º básico a 4º medio y 12 a 20 años de edad, de los cuales 189 eran de nivel socioeconómicoalto y 192 medio bajo, eligiendo por azar 8 mujeres y 8 hombres de cada uno de los cursos por cada año, nivel escolar, escuela de ambos niveles socioeconómicos. Los adolescentes mostraron escasos conocimientos sobre las enfermedades bucales más comunes y su prevención. Los dentistas del sector público parecen realizar proporcionalmente menos educación que los del sector privado y el resto de los profesionales de la salud parece no entregar información sobre salud oral. El estado de salud oral declarada es peor en el NSEMB, que asiste menos a consulta dental. Influyen en la baja demanda el horario de los servicios públicos y el miedo al dentista, que es mayor en este nivel. La mayoría de los jóvenes práctica cepillado dental, que es inadecuado en lato porcentaje de los casos, muy pocos utilizan flúor en enjuagatorios, 40 por ciento declaran sangramiento gingival, al que otorgan escasa importancia. La estética es la razón principal para el cuidado de la dentadura. Al consumo frecuente de azúcares se asocia a las caries, pero no al aumento de peso, efectos que debieran relacionarse en las intervenciones educativas. Parece conveniente disponer de un programa de atención dental específico para este grupo de edades e incorporar la salud oral en las acciones de educación para la salud que se ofrecen a los adolescentes y otras de detección precoz de las afecciones dentales de mayor prevalencia

Dental general anesthesia: clinical characteristics of 933 patients.

To initiate a study on the usefulness of dental treatment with general anesthesia, we investigated clinical characteristics of 933 patients who received total oral rehabilitation using general anesthesia at the Department of Restorative and Pediatric Dentistry of the University Hospital Leuven, Belgium. The median age of the patients was 10 years. The overall male-to-female ratio was 53 to 47. The principal indications for treatment using general anesthesia were rampant caries, fear, and a mental or physical handicap. The mean number of decayed teeth was 10.9 (sd 4.9). Nearly 50 percent of the patients were referred by a dentist.

[Oral rehabilitation under general anesthesia (an evaluation)]. / Rehabilitación bucal bajo anestesia general (una evaluación).

This prospective, 30-month study evaluates mouth restorations performed under general anesthesia on 219 patients at the Stomatology Unit of the National Institute of Pediatrics. The authors analyze characteristics of patients, treatments performed and complications.