Associação entre sintomas de disfunção temporomandibular e impacto nas dimensões física e psicossocial da qualidade de vida relacionada à saúde bucal: um estudo de base populacional / Association between temporomandibular disorder symptoms and impact on physical and psychosocial dimensions of oral health-related quality of life: a population-based study

Objetivou-se avaliar a associação entre sintomas da disfunção temporomandibular (DTM) e a presença de impacto físico e psicossocial das condições de saúde bucal entre adultos de um município de pequeno porte de Minas Gerais, Brasil. Estudo epidemiológico de base populacional foi realizado com amostra probabilística de adultos (30-50 anos). Entrevista e exame epidemiológico foram realizados por examinadoras calibradas (Kappa > 0.7). A variável dependente foi a presença de impacto físico e psicossocial das condições de saúde bucal, avaliada usando a versão validada no Brasil do Oral Health Impact Profile-14 (OHIP-14). A presença de impacto foi definida pelo relato de impacto "repetidamente" ou "sempre" em, pelo menos, uma das funções medidas pelo OHIP-14. A principal variável independente, presença de sintomas de DTM, foi avaliada por meio do Questionário Anamnésico de Fonseca (1994). As covariáveis foram: condições de saúde bucal (presença de cárie, doença periodontal e dentição reduzida), perfil sociodemográfico (sexo, idade e cor autodeclarada), perfil socioeconômico (escolaridade e renda) e comportamentos em saúde (tabagismo e consumo de bebidas alcóolicas). Análises descritivas, teste qui- quadrado e análise de associação pelo modelo de regressão de Poisson foram realizadas. Da amostra total de 197 participantes, 114 (59,30%) apresentaram impacto físico e psicossocial das condições de saúde bucal e 135 (68,19%) apresentaram, pelo menos, um sintoma de DTM. A presença de sintomas de DTM foi significativamente associada a maior prevalência de impacto, independente do perfil sociodemográfico e socioeconômico, das condições de saúde bucal e dos comportamentos em saúde dos adultos. Indivíduos com sintomas de DTM apresentaram prevalência de impacto 1,75 (IC 95%: 1,18 - 2,57) vezes maior que a prevalência observada entre aqueles que não relataram sintoma, sendo desconforto psicológico (60,46%), dor física (40,19%) e incapacidade psicológica (35,71%) as dimensões do OHIP-14 mais afetadas (p<0.01). A DTM é uma condição com alta prevalência na população e a presença de sintomas da disfunção está associada com impactos bucais nas diferentes dimensões da Qualidade de Vida Relacionada à Saúde Bucal (QVRSB). Esses resultados evidenciam a importância da identificação precoce da presença de sintomas de DTM para reduzir o impacto nas dimensões física e psicossocial da QVRSB e de incorporar a DTM como tema essencial na prática de profissionais de saúde, na formação acadêmica das universidades e na formulação de políticas públicas.

The objective of this study was to evaluate the association of the symptoms of temporomandibular disorder (TMD) with the presence of physical and psychosocial impact of oral health conditions among adults in a small city in Minas Gerais, Brazil. A population-based epidemiological study was carried out with a probabilistic sample of adults (30-50 years). Interview and epidemiological examination were performed by calibrated examiners (Kappa> 0.7). The dependent variable was the presence of physical and psychosocial impact of oral health conditions, assessed using the validated version in Brazil of the Oral Health Impact Profile-14 (OHIP-14). The presence of impact was defined by the impact report "repeatedly" or "always" in at least one of the functions measured by OHIP-14. The main independent variable, presence of TMD symptoms was assessed using the Anamnesis Questionnaire of Fonseca (1994). The covariables were oral health conditions (presence of caries, periodontal disease and reduced dentition), sociodemographic profile (sex, age and self-declared skin color), socioeconomic profile (education and income) and health behaviors (smoking and consumption of alcoholic beverages). Descriptive analyzes, chi-square test and association analysis using the Poisson regression model were performed. Of the total sample of 197 participants, 114 (59.30%) had a physical and psychosocial impact of oral health conditions and 135 (68.19%) had at least one TMD symptom. The presence of TMD symptoms was significantly associated with a higher prevalence of impact, regardless of oral health conditions, sociodemographic and socioeconomic profile and health behaviors of the adults interviewed. Individuals with TMD symptoms had a prevalence of impact 1.75 (95% CI: 1.18 - 2.57) times higher than that observed among those who did not report any symptoms, being psychological discomfort (60.46%), physical pain (40.19%) and psychological disability (35.71%) the dimensions of the OHIP-14 most affected (p <0.001). TMD is a condition with high prevalence in the population and the presence of symptoms of dysfunction is associated with oral impacts on different dimensions of Oral Health Related Quality of Life (OHRQoL). These results show the importance of early identification of the presence of TMD symptoms to reduce the impact on the physical and psychosocial dimensions of OHRQoL and to incorporate TMD as an essential theme in the practice of health professionals, in the academic formation of universities and in the formulation of public policies.

Dependence on others for oral hygiene and its association with hand deformities and functional impairment in elders with a history of leprosy.

OBJECTIVE: To analyse the frequency of dependence on others for oral hygiene and its association with hand deformities, frailty and dependence on others for basic activities of daily living (BADL) among elders with a history of leprosy. BACKGROUND: Dependence on others for oral hygiene has not been considered in multifunctional geriatric assessments. MATERIAL AND METHODS: Edentulous elders with a history of leprosy who used complete dentures and resided in a former leprosy colony were classified as independent or partially/completely dependent on others for brushing their dentures or rinsing and for BADL, and as frail or robust. The presence of hand deformities was assessed by an occupational therapist. RESULTS: 28.4% and 14.9% were completely/partially dependent on others for brushing and rinsing, respectively. The dependence for BADL was observed in 21.6% and hand deformities in 17.6%. A higher odds of dependence for brushing/rinsing was found among elders who were dependent on others for BADL. Brushing dependence (61.5%) was more frequent among participants with hand deformities than those without this condition (21.3%) (OR: 6.8; 95% IC: 1.2-37.9; P = .028). There was no association between frailty and brushing (P = .068) or rinsing (P = .202) dependence. CONCLUSION: Approximately one-third of elders have a dependence on others for brushing; a smaller proportion is dependent on others for rinsing. Older people who are dependent on others for BADL and who present hand deformities are more likely to be dependent on others for denture brushing and rinsing. Elders may perform oral self-care even when they present frailty.

Oferta de próteses dentárias na Atenção Primária à Saúde de 2010 a 2016 em Belo Horizonte, Minas Gerais / Supply of dental prostheses in Primary Health Care from 2010 to 2016 in Belo Horizonte, Minas Gerais

Objetivo: O objetivo do presente estudo foi descrever a implementação e oferta de próteses totais removíveis (PT) na Atenção Primária à Saúde (APS) entre 2010-2016, no município de Belo Horizonte (BH). Métodos: Pesquisa documental na nota técnica sobre oferta de PT no Sistema Único de Saúde; legislações e dados sobre credenciamento de Laboratórios Regionais de Prótese Dentária (LRPD) em BH e protocolo para Atenção em Saúde Bucal do município. Com base no consolidado de produtividade das Unidades Básicas de Saúde (UBS) e na nota técnica "Oferta de Prótese Dentária na Rede SUS-BH", 2012, obteve-se o número de próteses ofertadas de 07/2010 a 07/2016 e as taxas de oferta, considerando-se a população estimada com necessidade de PT. Resultados: Em 2004, a Política Nacional de Saúde Bucal instituiu a oferta de próteses na APS. Em 2006, o Protocolo para Atenção em Saúde Bucal definiu a oferta de próteses parciais e totais removíveis em acrílico na APS. Em 2008, houve edital de credenciamento de LRPD. Em 2010, iniciou-se a oferta de PT e houve credenciamento de um LRPD. Cursos de capacitação e suporte por tutor especialista foram disponibilizados. Em 2016, cento e quarenta e oito UBS estavam capacitadas para produção de PT, que foi de 900 próteses em 2010 e 4.573 em 2016, totalizando 25.784 PT ofertadas à população. O aumento foi de 87,6% de 2011 para 2012 e de 44,7% de 2012 para 2013; de 2013 para 2014 reduziu 1,2% e cresceu 15,2% de 2014 para 2015. Houve um aumento nas taxas de produção anual e mensal de próteses. Conclusão: Houve uma ampliação da oferta de PT pela APS de BH. A tutoria e os cursos de capacitação favoreceram a adesão e aperfeiçoamento dos cirurgiões-dentistas na oferta desse serviço.(AU)

Aim: To describe the implementation and supply of total removable dentures (PT) in Primary Healthcare (PHC) between the years of 2010 and 2016 in the city of Belo Horizonte (BH), Brazil. Methods: Documentary research in technical notes on the supply of dental prostheses in the Brazilian Unified Health System (SUS); legislations and data on the accreditation of Regional Dental Prosthesis Laboratories (LRPD) in BH; and protocol for Oral Healthcare in BH. The number of dentures provided from 07/2010 to 07/2016 was obtained based on the consolidated productivity of Basic Health Units (UBS) and the technical notes of "Supply of Dental Prosthesis in the SUS-BH Network" (2012). Results: In 2004, the National Oral Health Policy instituted the supply of prostheses in PHC. In 2006, the Protocol for Oral Healthcare defined the supply of partial and total removable acrylic dentures in PHC. In 2008, there was a bidding process for LRPD accreditation. In 2010, PT began to be provided, and LRPD was accredited. Training and support courses by specialist tutors were provided. In 2016, one hundred fortyeight UBSs were qualified to produce PT, which reached 900 prostheses in 2010 and 4,573 in 2016, with a total of 25,784 PTs offered to the population. The increase was of 87.6% from 2011 to 2012 and of 44.7% from 2012 to 2013; from 2013 to 2014, this number decreased by 1.2%, while it increased 15.2% from 2014 to 2015. Conclusion: There was an expansion of the PTs provided by APS in BH. Tutoring and training courses favored the adherence and improvement of dentists in providing this service.(AU)