Dental vulnerability scale in primary health care: evidence of content and structure internal validity.

BACKGROUND: Access to oral health services remains a challenge in the Brazilian healthcare system, especially in the primary health care setting, where the use of a risk stratification tool that could identify individuals with higher dental vulnerability would be extremely valuable. However, there literature on this theme is scarce, and there is no validated instrument in Brazil that is capable of measuring dental vulnerability. Hence, this psychometric study aimed at the development and evaluation of content and internal structure validity of the Dental Vulnerability Scale for Primary Health Care (PHC). METHODS: The items were developed based on a qualitative exploratory analysis. A total of 172 items were prepared and submitted to a panel of specialists, with content validity analyzed with the Content Validity Ratio (CVR), resulting in an the initial version of the instrument composed by 41 items. Internal structure validity was analyzed by Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and by applying 3 reliability indicators (Cronbach's Alpha, McDonald's Omega and Greatest Lower Bound - GBL), with a sample of 1227 individuals. RESULTS: The final configuration indicated a scale of 15 items divided into 4 dimensions (overall health, oral health, infrastructure, and healthcare services) with explained variance of 72.11%. The factor loads varied from 0.37 to 0.96. The model adjustment indices were set at × 2/df(51) = 3.23, NNFI = 0.95, CFI = 0.98, GFI = 0.96, AGFI = 0.97, RMSEA = 0.04 and RMSR = 0.03. CONCLUSION: DVS presented satisfactory evidence of validity, indicating its suitability to be used by healthcare professionals, students and managers to plan oral health actions and services at PHC.

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.

Social determinants and use of dental floss by 35-44-year-old adults / Determinantes sociais e o uso de fio dental por adultos de 35 a 44 anos de idade

Objective: To analyze social, economic and demographic variables associated with the use of dental floss by 35-44-year-old adults living in the district of Embu, 2008. Methods: A cross-sectional type study in which an inquiry was applied and oral conditions were examined. The sample delineation was conglomeration probabilistic in two stages of random selection (censor sectors and eligible homes). The dependent variable was the use of dental floss in daily oral hygiene practices. The independent variables were social economic and demographic conditions, access to health services, habits and presence of caries and periodontal diseases. EPIINFO 06 and STATA 10 programs were used for Poisson regression analysis with adjustment for conglomeration sample.Results: Of persons interviewed 52.1% stated that they did not use dental floss. In the multivariate model there was an association of non use of dental floss for men (PR=1,61 p=0,00), with those who declared having smoking habit (PR=1.24 p=0.04); with family income equal to or less than one minimum salary (PR=1.62 p=0.00); who had up to 8 years of schooling (PR=1.42 p=0.01); who did not receive information from the dentist about cleaning the teeth and gums (PR=1.27 p=0.02), and who presented severe periodontal diseases with clinical attachment loss >3.5mm (PR=1.05 p=0.00). Conclusion: The research showed that the lack of dental floss use is a socially related behavior. Therefore, fair social policies is needed in order to minimize social inequalities, and ensure adult oral health educational programs.

Objetivo: Analisar as variáveis sócio econômicas e demográficas associadas ao uso do fio dental em adultos de 35 a 44 anos no município de Embu, 2008. Métodos: Estudo do tipo transversal no qual foi aplicado um inquérito e realizado um exame das condições bucais. O delineamento da amostra foi probabilístico por conglomerado em dois estágios de sorteio (setores censitários e domicílios elegíveis). A variável dependente foi o uso do fio dental nas práticas diárias de higiene bucal. As variáveis independentes: condições sócio demográficas, sócio econômicas, acesso aos serviços, hábitos, presença de cárie dentária e doença periodontal. Empregou-se o programa EPIINFO 06 e o STATA 10, foi usado o modelo de regressão de Poisson com ajuste para amostragem complexas. Resultados: A percentagem de pessoas relatando que não utilizavam o fio dental foi de 52,1%. No modelo de análise multivariável demonstrou que houve associação para o não uso do fio dental entre os homens (RP=1,61 p=0,00), que relataram o hábito de fumar (RP=1,24 p=0,04), com renda familiar menor ou igual a um salário mínimo (RP=1,62 p=0,00), que apresentavam até 8 anos de estudo (RP=1,42 p=0,01), que não receberam informação do cirurgião-dentista sobre higiene bucal (RP=1,27 p=0,02), e apresentam perda de inserção periodontal superior a 3,5mm (RP=1,05 p=0,00). Conclusão: A pesquisa demonstrou que não usar o fio dental de maneira regular é um comportamento socialmente determinado, verifica-se a necessidade de elaboração de políticas socialmente mais justas que minimizem as iniquidades sociais, com ações de educação de saúde bucal voltadas para adultos