Admission of dentist in Brazilian Universal Health System (SUS): a priority agenda for the strengthening of Smiling Brazil. / Mecanismos de ingresso de dentistas no SUS: uma agenda prioritária para o fortalecimento do Brasil Sorridente.

This article aims at: i) describing and analyzing the expansion of dental care in the Unified Health System (SUS); ii) Identifying and analyzing the characteristics of hiring dentists' in the public service; iii) characterizing public vacancies, their duties and remuneration. In this descriptive case study, databases of the Ministry of Health were consulted and public tender notices. The findings indicate that 48% of the dentists enrolled in the National Registry of Health Establishments (CNES) perform care in the SUS, in 13 years there was an increase of 118% of the municipalities with oral health teams (eSB) implanted. The population coverage estimated by eSB increased by 10.46% between the years 2007 and 2015. The main mechanism for joining the Dental Specialties Centers (CEO) was the public tender. Primary care salaries ranged from 1.05 to 12.67 Brazilian minimum wages, to 40-hour weekly jobs, and to CEOs from 3.35 to 7.05. It is concluded that, among other measures, the planning of HRH strategies is necessary. The continuity of successes regulatory measures of labor contracts and support to local managers enter the agenda of priority actions of oral health policy.

Este artigo objetiva i) descrever e analisar a expansão do provimento de dentistas no Sistema Único de Saúde (SUS); ii) identificar e analisar as características do vínculo trabalhista dos dentistas com o serviço; iii) caracterizar as vagas em concurso público, no que se refere aos requisitos, atribuições e remuneração. Neste estudo de caso, descritivo, foram consultados bancos de dados do Ministério da Saúde e editais de concurso público. Os achados apontam que 48% dos dentistas cadastrados no Cadastro Nacional dos Estabelecimentos de Saúde (CNES) realizam atendimento no SUS, em 13 anos observou-se um aumento de 118% dos municípios com equipes de saúde bucal (eSB) implantadas. A cobertura populacional estimada pelas eSB aumentou 10,46% entre os anos de 2007 e 2015. O principal mecanismo de ingresso nos Centros de Especialidades Odontológicas (CEO) foi o concurso público. O salário na atenção primária variou de 1,05 a 12,67 salários mínimos, para cargos de 40 horas semanais e nos CEOs de 3,35 a 7,05. Conclui-se que é necessário, entre outras medidas, o planejamento de estratégias voltadas aos recursos humanos em saúde. A continuidade dos êxitos alcançados demanda que medidas regulatórias dos contratos de trabalho e apoio aos gestores entrem na agenda das ações da política em saúde bucal.

Educação Permanente em Saúde e o Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica: um estudo transversal e descritivo / Permanent Health Education and National Program for Improving Access and Quality of Primary Care: a cross-sectional and descriptive study

RESUMO A Educação Permanente em Saúde, contemplada pelo Ministério da Saúde como política institucional, constitui um dos pilares de estratégico potencial de transformação dos processos no Sistema Único de Saúde. Este estudo transversal e descritivo obteve um painel brasileiro da Educação Permanente em Saúde, a partir de dados secundários do Ministério da Saúde, extraídos do censo de avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica no 2º Ciclo (2013), realizado com Equipes de Saúde da Família com adesão ao Programa no período (n=10.213/100%); 90% (n=9.184) das equipes afirmaram participar de atividades de Educação Permanente em Saúde, com maiores frequências das regiões Sudeste, Nordeste e Sul. As principais atividades de Educação Permanente em Saúde relatadas foram seminários, mostras, oficinas e grupos de discussão (n=8.243/80,71%), além de cursos presenciais (n=7.808/76,45%). Das opções ofertadas pelo Ministério da Saúde, a menos frequente foi a Rede Universitária de Telemedicina (n=475/4,65%); 87,62% (8.948) Equipes de Saúde da Família tiveram suas demandas de Educação Permanente em Saúde atendidas pela gestão. O instrumento apresenta robustez de dados e contempla diversos aspectos da gestão, incluindo elementos importantes de Educação Permanente em Saúde que podem nortear a tomada de decisão e interferir em políticas e programas próprios nos serviços.

ABSTRACT The Permanent Health Education, contemplated by the Ministry of Health as an institutional policy, is one of the pillars of strategic potential for the transformation of the processes in the Unified Health System. This cross-sectional and descriptive study investigated the Brazilian panorama of Permanent Health Education, from secondary data of the Ministry of Health, extracted from the external evaluation census of the National Program for Improving Access and Quality of Primary Care in the 2nd Cycle (2013), carried out with Family Health Teams, with adherence to the Program in the period (n=10.213/100%); 90% (n=9.184) of the teams responded to participate in Permanent Health Education activities, with greater frequency in the Southeast, Northeast and South regions; the main Permanent Health Education activities reported were seminars, shows, workshops and discussion groups (n=8.243/80.71%) in addition to presential courses (n=7.808/76.45%). Of the options offered by the Ministry of Health, the least frequent was the Telemedicine University Network (n=475/4.65%); 87.62% (8.948). Family Health Teams had their Permanent Health Education demands met by management. The instrument presents data robustness and contemplates several aspects of management, including important elements of Permanent Health Education that can guide decision making and interfere with their own policies and programs in the services.

Mecanismos de ingresso de dentistas no SUS: uma agenda prioritária para o fortalecimento do Brasil Sorridente / Admission of dentist in Brazilian Universal Health System (SUS): a priority agenda for the strengthening of Smiling Brazil

Resumo Este artigo objetiva i) descrever e analisar a expansão do provimento de dentistas no Sistema Único de Saúde (SUS); ii) identificar e analisar as características do vínculo trabalhista dos dentistas com o serviço; iii) caracterizar as vagas em concurso público, no que se refere aos requisitos, atribuições e remuneração. Neste estudo de caso, descritivo, foram consultados bancos de dados do Ministério da Saúde e editais de concurso público. Os achados apontam que 48% dos dentistas cadastrados no Cadastro Nacional dos Estabelecimentos de Saúde (CNES) realizam atendimento no SUS, em 13 anos observou-se um aumento de 118% dos municípios com equipes de saúde bucal (eSB) implantadas. A cobertura populacional estimada pelas eSB aumentou 10,46% entre os anos de 2007 e 2015. O principal mecanismo de ingresso nos Centros de Especialidades Odontológicas (CEO) foi o concurso público. O salário na atenção primária variou de 1,05 a 12,67 salários mínimos, para cargos de 40 horas semanais e nos CEOs de 3,35 a 7,05. Conclui-se que é necessário, entre outras medidas, o planejamento de estratégias voltadas aos recursos humanos em saúde. A continuidade dos êxitos alcançados demanda que medidas regulatórias dos contratos de trabalho e apoio aos gestores entrem na agenda das ações da política em saúde bucal.

Abstract This article aims at: i) describing and analyzing the expansion of dental care in the Unified Health System (SUS); ii) Identifying and analyzing the characteristics of hiring dentists' in the public service; iii) characterizing public vacancies, their duties and remuneration. In this descriptive case study, databases of the Ministry of Health were consulted and public tender notices. The findings indicate that 48% of the dentists enrolled in the National Registry of Health Establishments (CNES) perform care in the SUS, in 13 years there was an increase of 118% of the municipalities with oral health teams (eSB) implanted. The population coverage estimated by eSB increased by 10.46% between the years 2007 and 2015. The main mechanism for joining the Dental Specialties Centers (CEO) was the public tender. Primary care salaries ranged from 1.05 to 12.67 Brazilian minimum wages, to 40-hour weekly jobs, and to CEOs from 3.35 to 7.05. It is concluded that, among other measures, the planning of HRH strategies is necessary. The continuity of successes regulatory measures of labor contracts and support to local managers enter the agenda of priority actions of oral health policy.

Effect of Nd:YAG and CO2 Laser Irradiation on Prevention of Enamel Demineralization in Orthodontics: In Vitro Study.

OBJECTIVE: The aim of this study was to investigate Nd:YAG and CO2 laser effects in the prevention of demineralization in deeper layers of enamel via successive acid challenge cycles. BACKGROUND DATA: Lasers are promising in the prevention of enamel demineralization around the orthodontic brackets; however, there are very few studies that evaluate if the effects of treatment could be extended after successive acid challenge cycles due to permanent enamel structural alterations. MATERIALS AND METHODS: Human enamel samples were divided into five groups (n = 12): G1-application of 1.23% acidulated fluoride phosphate gel (AFP, control); G2-Nd:YAG laser irradiation (0.6 W, 84.9 J/cm2, 10 Hz, 110 µs, contact mode); G3-Nd:YAG laser irradiation associated with AFP; G4-CO2 laser irradiation (0.5 W, 28.6 J/cm2, 50 Hz, 5 µs, and 10 mm focal distance); and G5-CO2 laser irradiation associated with AFP. The samples were submitted to successive acid challenge cycles. Quantitative light-induced fluorescence and scanning electron microscopy were used to assess enamel demineralization. The data were statistically compared (α = 5%). RESULTS: G1: 50.87 ± 4.57; G2: 47.72 ± 2.87; G3: 50.96 ± 4.01; G4: 28.21 ± 2.19; and G5: 30.13 ± 6.38. The CO2 laser groups had significantly lower mineral losses than those observed in all other groups after successive acid challenge cycles. CONCLUSIONS: Only the CO2 laser (10.6 µm) irradiation prevents enamel demineralization around the orthodontic brackets even after exposure to successive acid challenges. The CO2 laser at 10.6 µm showed a deeper effect in enamel regarding caries prevention.

A formação de educadores em saúde da família: uma agenda para atividades futuras em Odontologia / The training of educators in family health: an agenda for future activities in Dentistry

A residência multiprofissional é uma modalidade de pós-graduação que agrega graduados de diversas áreas da saúde e que visa a consonância da formação com as necessidades do serviço público, tendo como cenário de prática a atenção primária, principalmente por meio da Estratégia de Saúde da Família. Este estudo tem como objetivo analisar a percepção de cirurgiões-dentistas, egressos da residência multiprofissional, sobre a atuação de dois tipos de educadores desse processo: os tutores e preceptores. O estudo, de abordagem qualitativa, constituiu-se em duas etapas: a análise documental do curso da Residência Multiprofissional da Faculdade Santa Marcelina de São Paulo e a realização de entrevistas semiestruturadas com os cirurgiões-dentistas egressos do curso em questão. Após a análise, foi possível concluir que o papel do tutor e do preceptor não estava bem definido no processo de formação dos residentes, situação que dificulta a atuação dos mesmos na prática do serviço. Tornase evidente a necessidade de um melhor preparo e definição do papel destes profissionais para que as práticas pedagógicas sejam operadas a contento. Da mesma forma, se evidencia a necessidade da institucionalização da formação de recursos humanos em saúde de nível multiprofissional, nas agendas das instituições de ensino superior, a fim de que se alcance o fortalecimento da proposta na atenção primária com vistas à promoção, prevenção e recuperação da saúde da população (AU).

The multi-professional residency is a kind of graduate program that gathers health professionals and aims the consonance of the academic education with the public health needs that will take place in primary health care, especially through the Family Health Strategy. This study aims to analyze the perspective of the dental professionals coming from the multiprofessional residency, on the roles of two kinds of educators: tutors and supervisors. The qualitative approach study consists of two steps: document analysis of the multiprofessional residency course at Faculty Santa Marcelina of São Paulo and semistructured interviews with the dentists who graduated from that course. After this analysis it was possible to conclude that the roles of the tutors and supervisors was not clearly defined in the process of the residence academic education, thus making it difficult for them to perform their tasks. The need of a better preparation and definition of these professionals' role is essential for the proper performance of pedagogical practices. Likewise, the need of an Institutionalization of the Human Resources formation becomes evident, in a multi-professional health level, in the curricula of the higher education institutions, in order to enhance this proposal in the primary health care contributing with the promotion, prevention and recovery of people's health (AU).

New uses for rehabilitation protocol for oral sinus communications in ARONJ patients.

This report presents a new use for rehabilitation protocol for oral sinus communications in patients with antiresorptive agent-induced osteonecrosis of the jaw. The treatment plan consisted of constructing an atraumatic complete denture with rounded edges, made with nontoxic resin, to prevent any injury to the mucosa and recurrence of the disease. The patient was followed up for 4 years, without any complications, and was socially reintegrated by resuming the normal life he experienced before tooth loss.

Reorganization of secondary and tertiary health care levels: impact on the outcomes of oral cancer screening in the São Paulo State, Brazil.

This study presents the strategies for prevention and early detection of oral cancer by means of screening in the elderly population of São Paulo, the richest and the most populous state of Brazil. This research was a retrospective longitudinal study based on the analysis of secondary data. The variables - number of participating cities, coverage of screening, and number of suspicious and confirmed cases of oral cancer - were divided into two periods: 2001-2004 and 2005-2008. Data were analyzed statistically by the chi-square test at 5% significance level. The implementation of a nationwide public oral health policy in 2004 and the reorganization of the secondary and tertiary health care were evaluated as mediator factors able to interfere in the achieved outcomes. From 2001 to 2008, 2,229,273 oral examinations were performed. There was an addition of 205 participating cities by the end of the studied period (p<0.0001). The coverage of oral cancer screening increased from 4.1% to 16% (p<0.0001). There was a decrease in the number of suspicious lesions (from 9% in 2005 to 5% in 2008) (p<0.0001) and in the rate of confirmed oral cancer cases per 100,000 examinations (from 20.89 in 2001 to 10.40 in 2008) (p<0.0001). After 8 years of screening, there was a decrease in the number of suspicious lesions and confirmed cases of oral cancer in the population. The reorganization of secondary and tertiary health care levels of oral care seems to have contributed to modify these numbers, having a positive impact on the outcomes of oral cancer screening in the São Paulo State.

[Strategies and results of the oral cancer prevention campaign among the elderly in São Paulo, Brazil, 2001 to 2009]. / Estratégias e resultados da prevenção do câncer bucal em idosos de São Paulo, Brasil, 2001 a 2009.

OBJECTIVE: To describe the strategies and results obtained by the early diagnosis and prevention of an oral cancer campaign targeting the population aged 60 years or older developed since 2001 in the state of São Paulo. METHODS: The main strategies used to develop the campaign were described based on the review of documents issued by the Health Ministry, National Cancer Institute, São Paulo State Health Department, Oncocentro Foundation of São Paulo, São Paulo City Health Department, School of Public Health at the University of São Paulo (USP), and Santa Marcelina Health Care Center. The impact of the campaign on the incidence of new cases of oral cancer in the target population was evaluated. RESULTS: In 2001, 90,886 elderly were examined vs. 629,613 in 2009. The following strategies were identified: training of professionals, development of printed materials to guide municipal governments in developing the campaign and using standardized codes and criteria, guidelines for data consolidation, establishment of patient referral flows, practical training with a specialist at the basic health care unit after the follow-up examination of individuals presenting changes in soft tissues, and increase in the number of oral diagnosis services. Between 2005 and 2009, there was a significant reduction in the rate of confirmed cases of oral cancer per 100,000 individuals examined, from 20.89 to 11.12 (P = 0.00003). CONCLUSIONS: The campaign was beneficial to the oral health of the elderly and could be extended to include other age groups and regions of the country. It may also provide a basis for the development of oral cancer prevention actions in other countries, as long as local characteristics are taken into account.

Estratégias e resultados da prevenção do câncer bucal em idosos de São Paulo, Brasil, 2001 a 2009 / Strategies and results of the oral cancer prevention campaign among the elderly in São Paulo, Brazil, 2001 to 2009

OBJETIVO: Descrever estratégias e resultados da campanha de diagnóstico precoce e prevenção do câncer bucal para a população com 60 anos ou mais desenvolvida desde 2001 no Estado de São Paulo. MÉTODOS: A partir de documentos publicados pelo Ministério da Saúde, Instituto Nacional de Câncer, Secretaria de Estado da Saúde de São Paulo, Fundação Oncocentro de São Paulo, Secretaria Municipal da Saúde de São Paulo, Faculdade de Saúde Pública da Universidade de São Paulo e Casa de Saúde Santa Marcelina, procurou-se evidenciar a problemática do câncer bucal e apresentar as principais estratégias utilizadas para desenvolver a campanha. Ainda, avaliou-se o impacto da campanha na incidência de casos novos de câncer bucal entre os examinados. RESULTADOS: Em 2001, foram examinados 90 886 idosos, contra 629 613 idosos em 2009. As estratégias identificadas foram: capacitação dos profissionais, desenvolvimento de material impresso para orientar os municípios sobre como conduzir a campanha, códigos e critérios a serem utilizados, orientações para a consolidação dos dados, estabelecimento de fluxos de referência, capacitação prática junto com o especialista na própria unidade de saúde a partir do reexame dos indivíduos que apresentavam alteração em tecidos moles e ampliação do número de serviços dirigidos ao diagnóstico bucal. Entre 2005 e 2009, houve redução significativa na taxa de casos confirmados de câncer bucal em cada 100 000 examinados, de 20,89 para 11,12 (P = 0,00003). CONCLUSÕES: A campanha trouxe benefícios à saúde bucal da população idosa. Pode ser ampliada para outros grupos etários e outras regiões do país e servir de subsídio para o desenvolvimento de ações de prevenção de câncer bucal em outros países, desde que respeitadas as características locais.

OBJECTIVE: To describe the strategies and results obtained by the early diagnosis and prevention of an oral cancer campaign targeting the population aged 60 years or older developed since 2001 in the state of São Paulo. METHODS: The main strategies used to develop the campaign were described based on the review of documents issued by the Health Ministry, National Cancer Institute, São Paulo State Health Department, Oncocentro Foundation of São Paulo, São Paulo City Health Department, School of Public Health at the University of São Paulo (USP), and Santa Marcelina Health Care Center. The impact of the campaign on the incidence of new cases of oral cancer in the target population was evaluated. RESULTS: In 2001, 90 886 elderly were examined vs. 629 613 in 2009. The following strategies were identified: training of professionals, development of printed materials to guide municipal governments in developing the campaign and using standardized codes and criteria, guidelines for data consolidation, establishment of patient referral flows, practical training with a specialist at the basic health care unit after the follow-up examination of individuals presenting changes in soft tissues, and increase in the number of oral diagnosis services. Between 2005 and 2009, there was a significant reduction in the rate of confirmed cases of oral cancer per 100 000 individuals examined, from 20.89 to 11.12 (P = 0.00003). CONCLUSIONS: The campaign was beneficial to the oral health of the elderly and could be extended to include other age groups and regions of the country. It may also provide a basis for the development of oral cancer prevention actions in other countries, as long as local characteristics are taken into account.

Tratamento Conservador de Osteorradionecrose de Mandíbula: Equidade e Racionalização de Recursos / Conservative Treatment of Mandibular Osteoradionecrosis: Equity and Rationalization of Resources

Relatar uma experiência de tratamento conservadore controle da ORN mandibular. Material e Métodos: Seis casosde ORN foram tratados com aplicação tópica diária desolução aquosa de gluconato de clorexidine à 0,12%, higienebucal rigorosa e eliminação de fatores irritantes à mucosa.As lesões orais de ORN tinham até 2cm no maior eixo. Oacompanhamento clínico foi realizado semanalmente até iníciode resposta ao tratamento e mensalmente após este período.A resposta à terapia foi classificada em: remissão total eparcial, aumento da lesão e ausência de resposta.Resultados: Dos seis pacientes, dois eram do sexo femininoe quatro do sexo masculino, com idades entre 39 a 78 anos.Todos os casos apresentaram resposta positiva tratamento,com três pacientes apresentando remissão parcial e trêscom remissão total. Após uma semana e meia, todos ospacientes relaram remissão total dos sinais prodrômicos daORN (dor e secreção purulenta). O tempo médio de tratamentofoi de 16,6 meses. Conclusão: Houve redução ou cura dosquadros clínicos dos casos acompanhados, e considera-seque esta evolução evitou o encaminhamento dos pacientespara câmara hiperbárica ou ainda a ressecção cirúrgica,deste modo, o tratamento relatado contribuiu para menormorbidade e racionalização de recursos do Sistema Únicode Saúde...

To report the results obtained in the conservativetreatment and control of mandibular ORN. Material andMethods: Six cases of ORN were treated with daily aqueoussolution of chlorhexidine gluconate 0.12% mouthwash,rigorous oral hygiene and removal of irritants to the mucosa.The oral lesions of ORN had up to 2 cm in greatest diameter.Clinical follow-up was conducted weekly until early responseto treatment and monthly, after that period. Response totherapy was classified as: total and partial remission,increased injury and absence of response. Results: Two ofthe six patients were female and four were male. Ages rangedfrom 39 to 78 years old. All cases showed some positiveresponse to the treatment, three patients had partial remissionand three patients had complete remission. In a week and ahalf, all patients presented total remission of ORN prodromalsigns (pain and purulent secretion). The average time oftreatment was 16.6 months. Conclusion: Reduction or totalheal of all ORN cases were achieved. It was noticeable thatthese results avoided indication of both hyperbaric oxygentherapy and surgical resection. Thus, thetreatment reported resulted in less morbidity to patients andrationalization of resources for the Public Health System...

Reorganization of secondary and tertiary health care levels: impact on the outcomes of oral cancer screening in the São Paulo State, Brazil

This study presents the strategies for prevention and early detection of oral cancer by means of screening in the elderly population of São Paulo, the richest and the most populous state of Brazil. This research was a retrospective longitudinal study based on the analysis of secondary data. The variables - number of participating cities, coverage of screening, and number of suspicious and confirmed cases of oral cancer - were divided into two periods: 2001-2004 and 2005-2008. Data were analyzed statistically by the chi-square test at 5% significance level. The implementation of a nationwide public oral health policy in 2004 and the reorganization of the secondary and tertiary health care were evaluated as mediator factors able to interfere in the achieved outcomes. From 2001 to 2008, 2,229,273 oral examinations were performed. There was an addition of 205 participating cities by the end of the studied period (p<0.0001). The coverage of oral cancer screening increased from 4.1% to 16% (p<0.0001). There was a decrease in the number of suspicious lesions (from 9% in 2005 to 5% in 2008) (p<0.0001) and in the rate of confirmed oral cancer cases per 100,000 examinations (from 20.89 in 2001 to 10.40 in 2008) (p<0.0001). After 8 years of screening, there was a decrease in the number of suspicious lesions and confirmed cases of oral cancer in the population. The reorganization of secondary and tertiary health care levels of oral care seems to have contributed to modify these numbers, having a positive impact on the outcomes of oral cancer screening in the São Paulo State.

Este estudo teve como objetivo apresentar as estratégias de prevenção e detecção precoce de câncer bucal, através de triagem (rastreamento) na população idosa do Estado de São Paulo. Esta pesquisa foi um estudo longitudinal retrospectivo baseado na análise de dados secundários. As variáveis -número de cidades participantes, a cobertura da triagem e o número de casos suspeitos e confirmados de câncer bucal - foram divididos em 2 períodos (2001-2004 e 2005-2008). As variáveis foram testadas através do teste do qui-quadrado. A implantação da política nacional de saúde bucal, em 2004, foi incluída como variável capaz de interferir nos resultados alcançados. De 2001 a 2008, 2.229.273 exames foram realizados. Foi observado um aumento de 205 cidades participantes até o final do período estudado (p<0,0001). A extensão do rastreamento para o câncer de boca aumentaram de 4,1% para 16% (p<0,0001). Houve uma diminuição no número de lesões suspeitas (de 9% em 2005 para 5% em 2008) (p<0,0001) e na taxa de casos confirmados de câncer bucal por 100.000 (20,89 em 2001 e 10,40 em 2008) (p=0,0003). Após 8 anos de triagem, observamos uma diminuição no número de lesões suspeitas e casos confirmados de câncer bucal entre os voluntários. É possível que a reorganização dos níveis secundário e terciário de cuidados bucais ajudou na modificação desses números.

Fatores Prognósticos no Câncer de Boca / Prognostic Factors in Oral Cancer

Objetivo: O presente trabalho se propôs a apresentar revisãode literatura sobre os fatores prognósticos clínicos maisrelevantes do câncer bucal. Método: Para elaboração deuma revisão da literatura, do tipo analítica e temática, pormeio da base de dados PUBMED e SCIELO, foram pesquisadosartigos da literatura médica da língua inglesa e portuguesapublicados no período de 1980 a 2009 com auxílio dos termos:fatores prognósticos, indicadores prognósticos, prognósticodo câncer oral, recorrência do câncer oral. Foram incluídosos artigos que abordavam o carcinoma epidermóide assimcomo as suas características clínicas, imaginológicas,estadiamento clínico, dentre outros aspectos, todos denatureza clínica. Foram excluídos os artigos cujasabordagens fossem referentes a experimentos e análiseslaboratoriais e que envolvessem marcadores tumorais ououtros indicadores moleculares do câncer. Resultados: Deum total de 15.542 artigos, 23 foram selecionados e foiobservado que lesões localizadas em regiões de difícilacesso cirúrgico em áreas anatômicas de maior circulaçãosanguínea ou linfática (como a língua) possuem piorprognóstico; quanto mais espesso o tumor e quanto maiorseu estadiamento TNM pior poderá ser a evolução dopaciente. Conclusão: Para as equipes multidisciplinares, quese dedicam ao tratamento desses doentes, o conhecimentoadequado da doença e dos seus fatores prognósticos devetornar cada membro apto à prevenção, identificação econtrole do câncer bucal...

Objective: The present work aimed to present a brief reviewof literature on the most relevant prognostic factors to theclinical prognosis of patients with oral cancer consideringthe experience with clinical cases treated at our Oral Center.Method: An analytic and thematic literature review wasperformed through the PubMed and SciELO database articles.Texts were searched in the English and Portuguese medicalliterature, which were published from 1980 to 2009. Thefollowing key-words were used: prognostic factors,prognostic indicators, oral cancer prognosis, and oral cancerrecurrence. Were included articles that addressed squamouscell carcinoma, since it is the most prevalent oral cancer, aswell as clinical features, imaging procedures, clinical stage,recurrence rates, and aggressive behavior related to themost significant prognostic factors such as patient age, tumorlocation, tumor thickness and TNM classification. Wereexcluded articles whose approaches were related tolaboratorial and experimental tests and involving tumormarkers or molecular indicators of oral cancer. Results: Froma total of 15.542 articles, twenty-three were selected aftercriteria application, and it was observed that lesions locatedin areas with difficult surgical access and with greater bloodor lymphatic circulation (such as the tongue) have a worseprognosis; greater tumor thickness and TNM staging areassociated with worst outcomes. Conclusion: Therefore,each member of the multidisciplinary group which assistsOSCC patients must comprehend this pathology and itsprognostic factors in order to become able to prevent,recognize and control the oral cancer...

[Popularization of oral self-examination: an example of non formal education--Part II]. / Popularização do autoexame da boca: um exemplo de educação não formal--Parte II.

One of the largest challenges of the universities, especially the public ones, is to transpose the scientific knowledge produced into their walls for the general population. The non-formal education is an important tool, and yet very little used by researchers and professors to approximate the scientific knowledge. The oral cancer reaches more than 11.000 Brazilians a year. In spite of the high incidence, this pathology is still little known by the general population and part of the medical and dental class. Basing on the epidemic data in researches and scientific papers, the oral cancer was the elect theme for the action in education and communication of the first national campaign with no government character of prevention in oral cancer, being a great example of as that can be made. This paper intends to describe the methodology used in communication and the results obtained in this successful experience.

Prevenção e Detecção Precoce do Câncer de Boca: Screening em Populações de Risco / Prevention and Early Detection of Oral Cancer: Screening in Risk Populations

Objetivo: Avaliar a viabilidade de programa de prevenção e diagnóstico precoce do câncer de boca direcionado a grupos considerados de risco para esta enfermidade, como tabagistas e etilistas crônicos.Método: No período entre junho de 2000 e julho de 2002, o programa foi realizado em pacientes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) e grupos de apoio comunitários, estruturado em palestras periódicas, exame bucal dos interessados e encaminhamento quando necessário para exames complementares e tratamento.Resultados: Foram examinadas 509 pessoas, das quais 215 pertenciam ao sexo masculino (42,2%), 59,7% eram brancos e com média de idade de 49,8 anos. Destas, 131 apresentaram lesão fundamental na boca, que foram encaminhadas à Faculdade de Odontologia da Universidade de São Paulo (FOUSP), para realização de exame complementar. Dos 48 (38,7%) pacientes que compareceram ao ambulatório, 11 foram submetidos à biópsia. Os achados das biópsias foram de hiperqueratose em 3, hiperplasia papilomatosa em 2, hiperplasia fibrosa em 3, um caso de displasia leve, um adenocarcinoma e um carcinoma epidermóide. À citologia esfoliativa, 5 pacientes tiveram o diagnóstico de classe I e 11 como classe II de Papanicolau.Conclusão: O elevado número de lesões fundamentais diagnosticadas demonstra ser de extrema importância o exame oral periódico de pacientes de risco, entretanto o método proposto, como deslocamento de equipes específicas para o rastreamento dos pacientes, mostrou-se bastante trabalhoso e oneroso para ser efetivamente incorporado em serviços de atenção à saúde. Por outro lado, serviços de atenção permanente em conjunto à atuação periódica de campanhas de esclarecimento a população, foram considerados os métodos de maior resultado para o diagnóstico precoce do câncer de boca

Objective: To evaluate a viability of a program for prevention and early diagnosis of oral cancer directed to groups considered at risk for this disease, such as chronic smokers and alcoholics.Method: The program was conducted between June 2000 and July 2002 with patients of the University Hospital of the Medical School of the University of São Paulo (HCFMUSP) and communitarian support groups, structured in the form of periodic lectures, oral exam for those who had interest, and, if necessary, referral for complementary exams and treatment.Results: 509 people were examined, of which 215 (42.2%) were males and 59.7% were Whites with mean age of 49.8 years. From these, 131 presented a fundamental lesion in the mouth and were referred to School of Dentistry of the University of São Paulo (FOUSP) for a complimentary exam. From the 48 (38.7%) patients that attended the University outpatient service, 11 were subjected to biopsy. Results of the biopsies were hyperkeratosis in 3 cases, papillomatous hyperplasia in 2, fibrous hyperplasia in 3, mild dysplasia in 1, adenocarcinoma in 1 and epidermoid carcinoma in 1. Based on the results of exfoliative cytology, 5 patients had diagnosis of Papanicolau class I and 11 of Papanicolau class II.Conclusion: The large number of fundamental lesions diagnosed demonstrates that periodic oral exam of high-risk patients is of paramount importance. However, the method proposed in this study, involving the transport of specific teams for screening of patients, appeared to be too demanding and costly to be effectively incorporated in public health attention services. On the other hand, permanent attention services together with periodic informative campaigns to the population were considered the methods with better results for the early diagnosis of oral cancer

Popularização do autoexame da boca: um exemplo de educação não formal - Parte II / Popularization of oral self-examination: an example of non formal education - Part II

Um dos maiores desafios das universidades, em especial das públicas, é transpor o conhecimento científico produzido entre seus muros para a população em geral. A educação não formal é uma ferramenta importante e ainda pouco utilizada pelos pesquisadores e docentes para aproximar o cotidiano do conhecimento científico. O câncer de boca atinge mais 11.000 brasileiros por ano. A despeito da alta incidência, esta patologia é ainda pouco conhecida da população em geral e de parte da classe médica e odontológica. Baseando-se nos dados epidemiológicos, em pesquisas e artigos científicos, o câncer de boca foi o tema eleito para a ação em educação e comunicação da primeira campanha nacional, de caráter não governamental, de prevenção de câncer de boca, um ótimo exemplo de como isso pode ser feito. Este trabalho se propõe a descrever a metodologia de comunicação utilizada e os resultados obtidos nesta experiência.

One of the largest challenges of the universities, especially the public ones, is to transpose the scientific knowledge produced into their walls for the general population. The non-formal education is an important tool, and yet very little used by researchers and professors to approximate the scientific knowledge. The oral cancer reaches more than 11.000 Brazilians a year. In spite of the high incidence, this pathology is still little known by the general population and part of the medical and dental class. Basing on the epidemic data in researches and scientific papers, the oral cancer was the elect theme for the action in education and communication of the first national campaign with no government character of prevention in oral cancer, being a great example of as that can be made. This paper intends to describe the methodology used in communication and the results obtained in this successful experience.

Photoelastic stress analysis surrounding implant-supported prosthesis and alveolar ridge on mandibular overdentures.

The purpose of this research was to evaluate the maximum stress around osseointegrated implants and alveolar ridge, in a mandible with left partial resection through a photoelastic mandibular model. The first group consisted of two implants: traditional model (T), implants placed in the position of both canines; fulcrum model (F), implants placed in the position of left canine CL and right lateral incisor LiR. Both models linked through a bar and clips. The second group was consisted of three implants, with implants placed in the position of both canines (CR and CL) and the right lateral incisor (LiR), which composed four groups: (1) model with 3 "O" rings, (2) model 2 ERAs, bar with clips, (3) model 2 ERAs bar without clips; (4) model "O" ring bar and ERA. An axial and an oblique load of 6.8 kgf was applied on a overdenture at the 1st Pm, 2nd Pm, and 1st M. Results showed that the area around the left canine (CL) was practically free of stress; the left lateral incisor (LiL) developed only small tensions, and low stress in all the other cases; the right canine tooth suffered the largest concentrations of stress, mainly with the ERA retention mechanism.

A Formação Humanística, Social e Ética do Graduando em Odontologia / Humanistic, Social and Ethical Education of Dental Undergraduate Students

Este estudo discute o significado das mudançascurriculares na Faculdade de Odontologia da Universidadede São Paulo e sua contribuição para a formação integral doaluno de graduação. Material e Métodos: Um estudoqualitativo foi conduzido por meio de análise etnográfica eanálise de conteúdo temática. A coleta de dados consistiuem observação-participante e análise documental.Resultados: A análise das atividades realizadas permitiuconcluir que grandes avanços têm sido percebidos a partirdesse processo de reestruturação como: qualificaçãopedagógica dos docentes, diversificação dos cenários deprática e reorganização do ensino da clínica. Contudo, amaior contribuição desse processo é o resgate dapreocupação da comunidade acadêmica com o ensino dagraduação. Conclusão: A fim de alcançar uma educaçãoodontológica integral que culmine com a mesma abordagempara o tratamento dos pacientes, é necessário ter oenvolvimento de toda a instituição. Isso ocorrerá por meio demudanças curriculares e da participação de todos osmembros do corpo docente, que devem se envolver noprocesso de formação humanística, social e ética dosestudantes de graduação...

This study debates the meaning of the curricularchanges at Sao Paulo State University Dental School and thecontribution of faculty for the comprehensive education ofundergraduate students. Material and Methods: A qualitativestudy was made through ethnographic analysis and thematiccontent analysis. Data collection consisted in participantobservation,documentary data. Results: Analysis of theactivities allow concluding that great advances have beenperceived from this process of curricular changes like facultypedagogical qualification, diversification of practice scenario,and reorganization of clinical education. But, one of the mostimportant considerations from the process was to regain theinterest in undergraduate education by academic community.Conclusion: In order to achieve a comprehensive dentaleducation extending the same approach to patient care it isnecessary to have the involvement of all institution. That willoccur through the curricular changes and participation of allfaculty members, who must become involved themselves inthe process of humanistic, social and ethical education ofthe undergraduate students...