Special care in dental curriculum: A transversal axis for integrating oral health with systemic health.

AIMS: Distance between dentistry and medicine is a traditional and historical obstacle that affects multiple levels of the health system, especially the health policies to improve health service quality. Changes in dental education, especially involving the adoption of integrative health models in professional development, are considered essential for reducing this gap. We aimed to show a dental curriculum focused on special care as a tool for medicine-dentistry integration. METHODS: In this study, we present a new proposal for an undergraduate dental curriculum in which topics related to special care are addressed transversally and are the core for interdisciplinary integration of oral health with systemic health. We also describe how themes related to dental home care and hospital dentistry were included in this course as basic professional competencies. RESULTS AND CONCLUSION: This initiative is aligned with the global trend to adopt educational systems that contribute to the reduction of health care inequalities and improve health service quality.

Risk assessment for oral urgent treatment in Primary Healthcare: a cross-sectional study.

BACKGROUND: The World Health Organization has advocated for the integration of dental care into the primary healthcare (PHC) setting, including oral urgent treatment (OUT). However, the knowledge necessary for OUT implementation in this setting is still limited. Thus, this study aimed to describe the impact of the implementation of oral disease risk assessment tools for oral health management in PHC. METHODS: This was a cross-sectional study that included individuals served by a single public PHC unit, with integrated oral healthcare teams, located in the south region of the city of São Paulo, Brazil, between April of 2015 and March of 2017. Data were collected from dental records. Three co-primary endpoints: same day treatment offered, first future appointment scheduled fulfilled, and treatment plan completed were compared before and after the implementation of oral disease risk assessment for OUT. RESULTS: A total of 1214 individuals that sought OUT, 599 before and 615 after the implementation of oral disease risk assessment for OUT were included in the study. All three co-primary endpoints had significant changes after the implementation of oral disease risk assessment for OUT. Individuals were significantly more likely to be offered same day treatment after (39.9%; 95% CI:36.0-43.9%) than before (9.4%; 95% CI: 7.2-12.0%), to fulfill their first future appointment scheduled after (34.9%; 95% CI:31.1-38.8%) than before (20.7%; 95% CI: 17.5-24.2%), and to have their treatment plan completed after (14.3%; 95% CI:11.6-17.4%) than before (10.0%; 95% CI: 7.7-12.7%) the intervention. CONCLUSIONS: This study provided evidence of the positive impact oral disease risk assessment tools could have in the organization of OUT in PHC settings.

Cytokines Levels and Salivary Microbiome Play A Potential Role in Oral Lichen Planus Diagnosis.

Oral lichen planus (OLP) is a chronic Th1-mediated inflammatory mucocutaneous disease of the skin and oral mucosa that can have various clinical presentations. Lesions are usually bilateral and often painful. While cutaneous Lichen Planus (LP) lesions are self-limiting, the oral lesions are chronic and rarely remissive. The diagnosis of oral lichen planus (OLP) is often challenging, and confirmation by histopathological criterion is generally advised. The aim of our study was to identify the cytokines present in OLP-suggestive lesions and in non-specific inflammatory lesions (NSIL) used as controls. Moreover, assess cytokines protein levels and oral microbiota composition in whole saliva samples. Histopathological analysis, immunohistochemistry and gene expression were used as techniques to analyze the oral mucosal tissue samples. ELISA was conducted to analyze salivary cytokine levels and 16S rRNA sequencing was used to determine the salivary microbiome. As a result we observed larger number of infiltrated lymphocytes (p = 0.025), as well, more T CD4 lymphocytes in the epithelial tissue (p = 0.006) in OLP samples compared to NSIL. In addition, the OLP samples displayed more apoptotic cells compared to NSIL (p = 0.047). Regarding the cytokine analysis, IFN-γ and IL-33 were more expressed in OLP lesions than in NSIL samples (p < 0.001; p = 0.026). Furthermore, our results demonstrated higher levels of IFN-γ protein expression in the saliva of OLP group compared to controls (p = 0.0156). We also observed noted differences in the oral microbiota composition between OLP and NSIL saliva samples. In conclusion, OLP lesions presented larger numbers of apoptotic and inflammatory cells, higher levels of IFN-γ and IL-33 compared to NSIL, and these lesions also differ regarding oral microbiota composition. These results are consistent with the Th-1-mediated chronic inflammation nature of oral lichen planus investigated lesions and displayed unique features that could be used as a diagnostic tool.

Assessment Between Dental Caries Index and Body Mass Index among Adults.

PURPOSE: To evaluate the relationship between decayed, missing and filled teeth (DMF index) and body mass index (BMI). MATERIALS AND METHODS: This was a cross-sectional, population-based study developed in 2015 at a primary health care (PHC) unit in the city of Sao Paulo, Brazil. Participants completed a form including sociodemographic and socioeconomic characteristics, nutritional, general health and oral health data. An anthropometric oral assessment was performed, and the association of DMFT and its components with not-categorised and categorised BMI was tested through simple and multiple logistic analysis, trend test and Spearman correlation. RESULTS: The sample consisted of 239 individuals aged 18 to 70 years. The prevalence of caries was 84.5%, the mean DMFT was 14.6 and the mean BMI was 27.46. There was positive association for DMFT with BMI and age, sex, formal education, hypertension, diabetes and use of dental floss. A positive association is also suggested between BMI and missing teeth. CONCLUSION: A correlation was observed between DMFT (missing teeth) and BMI. This can help to identify at-risk groups, plan progammes and treatment of overweight and obese individuals in primary health care.

Evolution of post-deployment indicators of oral health on the Family Health Strategy.

OBJECTIVE: To evaluate the evolution of indicators after the implementation of 21 Oral Healthcare Teams in the Family Health Strategy. METHODS: We used data from outpatient services of Oral Healthcare Teams to evaluate efficiency, access, percentage of absences and emergencies of oral healthcare professionals who worked in the partnership between the Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein and the Secretaria Municipal de Saúde de São Paulo, during the period 2009-2011. RESULTS: Percentages of emergencies, income, and access showed a significant difference during the period analyzed, but no difference for percentage of absences was found. When monthly analysis was made, it is noteworthy that at the beginning of service implementation a fluctuation occurred, which may indicate that the work was consolidated over the months, becoming capable of receiving new professionals and increasing the population served. Comparison of the indicators in that period with the goals agreed upon between the Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein and the Secretaria Municipal de Saúde de São Paulo made it possible to notice that the Oral Health Teams had a good performance. CONCLUSION: The results showed that the goals were achieved reflecting the increasing number of professionals, the maturing of work processes in the Oral Health Teams, and optimization of the manpower available to perform the activities. Understanding these results will be important to guide the actions of Oral Health Teams for the following years and to assess the achievement of goals.

Evolution of post-deployment indicators of oral health on the Family Health Strategy / Evolução de indicadores pós-implantação da saúde bucal na Estratégia Saúde da Família

Objective To evaluate the evolution of indicators after the implementation of 21 Oral Healthcare Teams in the Family Health Strategy. Methods We used data from outpatient services of Oral Healthcare Teams to evaluate efficiency, access, percentage of absences and emergencies of oral healthcare professionals who worked in the partnership between the Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein and the Secretaria Municipal de Saúde de São Paulo, during the period 2009-2011. Results Percentages of emergencies, income, and access showed a significant difference during the period analyzed, but no difference for percentage of absences was found. When monthly analysis was made, it is noteworthy that at the beginning of service implementation a fluctuation occurred, which may indicate that the work was consolidated over the months, becoming capable of receiving new professionals and increasing the population served. Comparison of the indicators in that period with the goals agreed upon between the Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein and the Secretaria Municipal de Saúde de São Paulo made it possible to notice that the Oral Health Teams had a good performance. Conclusion The results showed that the goals were achieved reflecting the increasing number of professionals, the maturing of work processes in the Oral Health Teams, and optimization of the manpower available to perform the activities. Understanding these results will be important to guide the actions of Oral Health Teams for the following years and to assess the achievement of goals. .

Objetivo Avaliar a evolução de indicadores após a implantação de 21 Equipes de Saúde Bucal na Estratégia Saúde da Família. Métodos Foram utilizados os dados de produção ambulatorial dos profissionais das Equipes de Saúde Bucal, o qual é o instrumento oficial utilizado pela Secretaria Municipal de Saúde de São Paulo para acompanhar o desempenho dos profissionais da saúde bucal em relação a rendimento, acesso, percentual de faltas e de urgências. Esses profissionais trabalharam na parceria entre a Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein e a Secretaria Municipal de Saúde de São Paulo, no período de 2009 a 2011. Resultados Para os indicadores: percentual de urgência, rendimento e acesso, houve diferença significativa entre os anos analisados. Para o indicador percentual de faltas, não houve diferença estatisticamente significante. Quando feita a análise mensal, destaca-se que, no início da implantação do serviço, ocorreu oscilação, podendo indicar que o trabalho foi consolidado ao longo dos meses, sendo capaz de receber novos profissionais e aumento da população atendida. Ao se compararem os indicadores do período com as metas pactuadas com a Secretaria Municipal de Saúde de São Paulo, é possível perceber que as Equipes de Saúde Bucal tiveram bom desempenho. Conclusão Os resultados alcançados junto às metas pactuadas certamente refletem o aumento do número de profissionais, o amadurecimento dos processos de trabalho dessas Equipes de Saúde Bucal e a otimização da mão de obra disponível para realização das atividades. O entendimento desses resultados é importante para nortear as ações das Equipes de Saúde Bucal para os anos ...