Cuidados em saúde bucal a crianças e adolescentes com paralisia cerebral: percepção de pais e cuidadores / Oral health care for children and adolescents with cerebral palsy: perceptions of parents and caregivers

Resumo Objetivou-se avaliar os cuidados em saúde bucal de crianças/adolescentes com Paralisia Cerebral (PC) segundo a gravidade, através da percepção dos pais/cuidadores. Estudo série de casos realizado em serviços de saúde de Pernambuco com 94 mães/cuidadores de sujeitos com PC entre 5 e 18 anos. Avaliaram-se fatores socioeconômicos, demográficos, cuidados em saúde bucal e uso de serviços odontológicos (SO). O Sistema de Classificação da Função Motora Grossa mostrou 67% com comprometimento motor grave. Indivíduos com PC grave tiveram frequência significantemente maior de pertencerem a famílias com renda mais baixa (89%, p < 0,001), residirem no interior (44%, p < 0,005), terem dificuldades de transporte (60%, p = 0,04) e acessibilidade aos SO (88%, p = 0,009) e maior necessidade de higiene bucal (67%, p = 0,008) realizada pelas mães (94%, p < 0,001). Apesar das barreiras de acesso aos SO, o mesmo foi facilitado para aqueles com PC grave, com uso precoce dos SO, mas com baixa oferta de dentistas e de humanização. Esses resultados informam problemas relacionados aos cuidados diários em saúde bucal, contexto de vida das famílias, de apoio institucional e de qualidade dos SO a serem enfrentados com políticas públicas socioeconômicas e de saúde integrais inclusivas e equânimes.

Abstract The aim was to evaluate the oral health care of children/adolescents with Cerebral Palsy (CP) according to severity through the perceptions of parents/caregivers. A case series study was conducted at health services in the state of Pernambuco, Brazil with 94 mothers/caregivers of subjects with CP from 5 and 18 years old. Sociodemographic factors, oral health care and use of dental services (DS) were evaluated. The Gross Motor Function Classification System showed 67% with severe motor impairment. Subjects with severe CP had significantly higher frequencies of belonging to families with lower income (89%, p < 0.001), living in the interior (44%, p < 0.005), having transportation difficulties (60%, p = 0.04), difficulty regarding access to DS (88%, p = 0.009) and a greater need for oral hygiene (67%, p = 0.008), which was performed exclusively by the caregiver (94%, p < 0.001). Despite identified access barriers, dental care was facilitated for those with severe CP, early DS use, but low availability of dentists and low degree of humanization were cited as major problems. These results reveal problems related to daily oral health care, family living context, institutional support and quality of DS that should be addressed in comprehensive, inclusive, equitable social and economic public policies.

Oral health care for children and adolescents with cerebral palsy: perceptions of parents and caregivers. / Cuidados em saúde bucal a crianças e adolescentes com paralisia cerebral: percepção de pais e cuidadores.

The aim was to evaluate the oral health care of children/adolescents with Cerebral Palsy (CP) according to severity through the perceptions of parents/caregivers. A case series study was conducted at health services in the state of Pernambuco, Brazil with 94 mothers/caregivers of subjects with CP from 5 and 18 years old. Sociodemographic factors, oral health care and use of dental services (DS) were evaluated. The Gross Motor Function Classification System showed 67% with severe motor impairment. Subjects with severe CP had significantly higher frequencies of belonging to families with lower income (89%, p < 0.001), living in the interior (44%, p < 0.005), having transportation difficulties (60%, p = 0.04), difficulty regarding access to DS (88%, p = 0.009) and a greater need for oral hygiene (67%, p = 0.008), which was performed exclusively by the caregiver (94%, p < 0.001). Despite identified access barriers, dental care was facilitated for those with severe CP, early DS use, but low availability of dentists and low degree of humanization were cited as major problems. These results reveal problems related to daily oral health care, family living context, institutional support and quality of DS that should be addressed in comprehensive, inclusive, equitable social and economic public policies.

Objetivou-se avaliar os cuidados em saúde bucal de crianças/adolescentes com Paralisia Cerebral (PC) segundo a gravidade, através da percepção dos pais/cuidadores. Estudo série de casos realizado em serviços de saúde de Pernambuco com 94 mães/cuidadores de sujeitos com PC entre 5 e 18 anos. Avaliaram-se fatores socioeconômicos, demográficos, cuidados em saúde bucal e uso de serviços odontológicos (SO). O Sistema de Classificação da Função Motora Grossa mostrou 67% com comprometimento motor grave. Indivíduos com PC grave tiveram frequência significantemente maior de pertencerem a famílias com renda mais baixa (89%, p < 0,001), residirem no interior (44%, p < 0,005), terem dificuldades de transporte (60%, p = 0,04) e acessibilidade aos SO (88%, p = 0,009) e maior necessidade de higiene bucal (67%, p = 0,008) realizada pelas mães (94%, p < 0,001). Apesar das barreiras de acesso aos SO, o mesmo foi facilitado para aqueles com PC grave, com uso precoce dos SO, mas com baixa oferta de dentistas e de humanização. Esses resultados informam problemas relacionados aos cuidados diários em saúde bucal, contexto de vida das famílias, de apoio institucional e de qualidade dos SO a serem enfrentados com políticas públicas socioeconômicas e de saúde integrais inclusivas e equânimes.

Escala de atitudes relacionadas às competências odontológicas: desenvolvimento e validação / Scale of attitudes related to dental competencies: development and validation

O objetivo do presente estudo foi desenvolver e realizar a validação de conteúdo e de face de uma escala de atitudes relacionadas às competências odontológicas (EA-CO). Tratou-se de estudo de desenvolvimento metodológico envolvendo construção e validação de uma escala, com abordagem quanti e qualitativa.O referencial teórico para o construto da escala envolveu o conceito de atitude no campo da Psicologia Social, e o de competência, no campo da Educação, qualificada pelas Diretrizes Curriculares Nacionais para os cursos deOdontologia,originando os indicadores: Empatia na relação profissional-paciente, Aprendizagem ao longo da vida, Disponibilidade para aprendizagem interprofissional, Proteção aos direitos do paciente, Responsabilidade social e Inteligênciaemocional. Dez especialistas participaram da validação de face da matriz de indicadores (Técnica do Grupo Nominal) e dos itens (Questionário) e a versão preliminar foi testada empiloto com17 estudantes de Odontologia. Houve consenso para permanência dosindicadores, exceto para Inteligência emocional. A escala (tipo Likert, 5 pontos) resultou em 53 itens,sendo 13 alterados da versão original.A EA-CO foi desenvolvida e atendeu aos critérios de validação de conteúdo e de face utilizados no estudo (AU).

This study aimed to develop and validate the content and face of a scale of attitudes related to dental competencies (SA-DC).It was a methodological development study involving the design and validation of a scale, using a quantitative and qualitative approach.The theoretical framework for the construct of the scale involved the concept of attitude in the field of Social Psychology and that of competence in the field of Education, qualified by the National CurriculumGuidelines for Dentistry Programs, thus providing the following indicators: Empathy in the professional-patient relationship, Lifelong learning, Readiness for interprofessional education, Protection of patients' rights, Social responsibility and Emotional intelligence.Ten experts participated in the face validation of the matrix of indicators (Nominal Group Technique) and of the items (Questionnaire), and the preliminary version was pilot tested with 17 undergraduate dentistry students.There was consensus on the permanence of the indicators, except for Emotional Intelligence.The scale (5-point Likert type) resulted in 53 items,13 of which were modified from the original version.SA-DC was developed and met the content and face validation criteria used in the study (AU).

Aprendizagem Baseada em Equipes no ensino odontológico: o que pensam os estudantes? / Team-Based Learning in Dentistry teaching: what do students think?

A aprendizagem baseada em equipes (ABE) é um método dinâmico que proporciona um ambiente motivador e cooperativo, com valorização da produção coletiva. O objetivo do presente estudo foi analisar a percepção de estudantes do curso de odontologia de uma universidade brasileira sobre o método ABE. Tratou-se de estudo transversal com amostra de conveniência (n=83), no qual cada aluno respondeu questionário autoaplicável - Instrumento de Avaliação de ABE pelo Estudante. Os dados foram analisados a partir de uma estatística descritiva. Verificou-se uma consistência interna moderada, aceitável (Alfa de Cronbach = 0,736). As médias das respostas obtidas indicaram que os estudantes demonstraram preferência e satisfação quanto ao uso do método ABE, sendo este capaz de despertar maior sentimento de responsabilidade. A aplicação do método ABE em disciplinas do curso de Odontologia foi percebido de forma positiva pela quase totalidade dos estudantes (AU).

Team-based learning (TBL) is a dynamic method that provides a motivating and cooperative environment, with appreciation of collective production. The aim of this paper was to analyze the perception of undergraduate dentistry students of a Brazilian university on the TBL method. This is a cross-sectional study with convenience sample (n = 83), in which each student answered a self-administered questionnaire - Student's TBL Evaluation Instrument. Data were analyzed based on descriptive statistics. Moderate, acceptable internal consistency (Cronbach's alpha = 0.736) was found. The means of answers obtained indicated that students showed preference and satisfaction regarding the use of the TBL method, being able to arouse greater sense of responsibility. The application of the TBL method was positively perceived by almost all dentistry students (AU).

Influence of head and linear growth on the development of malocclusion at six years of age: a cohort study.

The aim of this article was to evaluate the influence of biological and sociobehavioral factors on the development of malocclusions in children. This is a cross-sectional study nested in a cohort of 350 children who participated in a community intervention study. After six years, an active search identified 290 children with occlusal abnormalities. Socioeconomic status, linear growth, and nutritional status of the child at birth and at the time of measurement, as well as dietary and sucking habits, were investigated. Malocclusions were evaluated across three spatial planes - anteroposterior, vertical, and transverse. The prevalence of these anomalies was 64.5%, primarily in the anteroposterior plane. The logistic regression analysis revealed that pacifier use for 60 months or more, stunting as measured at age six, and reduced gain in head circumference from birth to six years of age, were significantly associated with the development of malocclusion in childhood. Head circumference and linear growth are associated with occlusal anomalies in infants, independent of pacifier sucking.

Opinião de cirurgiões dentistas sobre atividades de preceptoria na formação de estudantes de Odontologia de uma universidade brasileira / Dentists' opinion about preceptory activity in the training of Dentistry students from a Brazilian university

O objetivo deste estudo foi conhecer a opinião de cirurgiões-dentistas sobre a atividade de preceptoria desempenhada por eles nos estágios curriculares 1, 2 e 3 do curso de Odontologia da Universidade Federal de Pernambuco, realizados em unidades da Atenção Básica à Saúde no município de Recife. Realizou-se estudo descritivo e de abordagem quantitativa. De um universo de 36 cirurgiões-dentistas foram incluídos aqueles com no mínimo um ano de experiência como preceptor. Para a coleta de dados utilizou-se formulário de entrevista semiestruturada,submetido à validação de face e aplicado face a face. Todos os 26 preceptores que atenderam ao critério de inclusão foram entrevistados, sendo 80,8% mulheres; 92,3% com vínculo de trabalho efetivo; 96,2% pós-graduados, sendo 80,2% deles especialistas em Saúde da Família. Apenas 15,4% recebiam incentivos para preceptoria, mas não estavam satisfeitos; 11,2% receberam formação em preceptoria; 92,3% demandaram capacitação para exercê-la; 69,2% atuaram nos três tipos de estágios. Prevaleceu (76,3%) a preferência por atuar no estágio 3 (clínico) do que nos dois outros (extraclínicos). Para 65,3% deles a estrutura física e organizacional para exercer a preceptoria é ruim, 69,2% avaliaram como insatisfatório o apoio institucional do serviço e 57,7% o da universidade, apesar dos esforços da instituição formadora em promover educação permanente e presencial nos serviços. Os pontos positivos mais citados foram a troca de saberes com os estudantes e docentes e a importância de integrar o estudante ao Sistema Único de Saúde. Conclui-se que embora valorizem a preceptoria, prevaleceram insatisfações de ordem trabalhista, de condições de trabalho e de formação que precisam ser enfrentadas (AU).

This study aimed to know the opinion of dentists on the preceptorship activities performed in the dental curricular internships 1, 2 and 3 of Federal University of Pernambuco, carried out in units of basic attention to health in the city of Recife. Descriptive study and quantitative approach were carried out. From a universe of 36 dentists, were included those with at least one year of experience as preceptor. For the collection of data used A semi-structured interview, subjected to face validation and applied face to face, was used for data collection. All 26 preceptors who obeyed the inclusion criterion were interviewed, being 80.8% women; 92.3% with effective work link; 96.2% graduate, being 80.2% of them family health specialists. Only 15.4% received incentives for preceptorship, but they were not satisfied; 11.2% received training in preceptorship; 92.3% were trained to exercise it; 69.2% acted in the three types of internships. It prevailed (76.3%) the preference for acting in Stage 3 (clinical) than in the two others (nonclinical). According to 65.3% of the interviewed, physical and organizational structure to exercise the preceptorship is bad, 69.2% evaluated the institutional support of the service as unsatisfactory and 57.7% of the university, despite the efforts of training institution in promoting permanent education and presence in services. The most cited positive points were the exchange of knowing with the students and faculty, and the importance of integrating the student into the unique health system. It is concluded that although they value the governess, they have prevailed dissatisfactions of labor order, working conditions and training that need to be addressed (AU).

Factors associated with the utilization of dental health services by the pediatric population: an integrative review. / Fatores associados à utilização dos serviços de saúde bucal pela população pediátrica: uma revisão integrativa.

This integrative literature review aimed to analyze studies about factors associated with the utilization of dental health services by the pediatric population between zero and 15 years old, published between 2006 and 2016 and available in Portuguese, English or Spanish. A survey of articles in the Lilacs and Medline databases was carried out, using the search strategy: ("dental care/utilization" OR "dental health services/utilization") AND ("child" OR "child, preschool") AND NOT adult. To analyze the methodological quality, the adapted Critical Appraisal Skill Programme (CASP) and the Agency for Healthcare and Research and Quality (AHRQ) were used. The following predictors of use of dental health services stood out: factors associated with children or adolescents (age, frequency of tooth brushing, chronic conditions), caregivers (schooling, perception of child's dental health, perceived oral health needs), dentists (availability at night and on the weekends) and follow up of oral health by the family health team. These are inherent factors for the planning of oral health policies or programs for the pediatric population. However, these factors vary according to the context, and therefore, a contextual analysis should be conducted.

O objetivo desta revisão integrativa da literatura foi analisar estudos publicados entre 2006-2016, disponibilizados em português, inglês ou espanhol, sobre fatores associados à utilização dos serviços de saúde bucal pela população pediátrica entre 0 e 15 anos. Foi realizado um levantamento nas bases de dados Lilacs e Medline, utilizando a estratégia de busca: ("dental care/utilization" OR "dental health services/utilization") AND (child OR "child, preschool") AND NOT adult. Para análise da qualidade metodológica, utilizou-se o Critical Appraisal Skill Programme (CASP) adaptado e o Agency for Healthcare and Research and Quality (AHRQ). Destacam-se como preditores do uso: fatores da criança ou adolescente (idade, frequência de escovação, condições crônicas), do cuidador (escolaridade, percepção da saúde bucal do filho, necessidades bucais referidas), do dentista (disponibilidade à noite e nos finais de semana) e o acompanhamento da saúde bucal pela equipe de saúde da família. Estes fatores são inerentes ao planejamento de políticas ou programas em saúde bucal na população pediátrica, entretanto, variam de acordo com o contexto em que se inserem. Portanto, uma análise contextual é necessária.

Fatores associados à utilização dos serviços de saúde bucal pela população pediátrica: uma revisão integrativa / Factors associated with the utilization of dental health services by the pediatric population: an integrative review

Resumo O objetivo desta revisão integrativa da literatura foi analisar estudos publicados entre 2006-2016, disponibilizados em português, inglês ou espanhol, sobre fatores associados à utilização dos serviços de saúde bucal pela população pediátrica entre 0 e 15 anos. Foi realizado um levantamento nas bases de dados Lilacs e Medline, utilizando a estratégia de busca: ("dental care/utilization" OR "dental health services/utilization") AND (child OR "child, preschool") AND NOT adult. Para análise da qualidade metodológica, utilizou-se o Critical Appraisal Skill Programme (CASP) adaptado e o Agency for Healthcare and Research and Quality (AHRQ). Destacam-se como preditores do uso: fatores da criança ou adolescente (idade, frequência de escovação, condições crônicas), do cuidador (escolaridade, percepção da saúde bucal do filho, necessidades bucais referidas), do dentista (disponibilidade à noite e nos finais de semana) e o acompanhamento da saúde bucal pela equipe de saúde da família. Estes fatores são inerentes ao planejamento de políticas ou programas em saúde bucal na população pediátrica, entretanto, variam de acordo com o contexto em que se inserem. Portanto, uma análise contextual é necessária.

Abstract This integrative literature review aimed to analyze studies about factors associated with the utilization of dental health services by the pediatric population between zero and 15 years old, published between 2006 and 2016 and available in Portuguese, English or Spanish. A survey of articles in the Lilacs and Medline databases was carried out, using the search strategy: ("dental care/utilization" OR "dental health services/utilization") AND ("child" OR "child, preschool") AND NOT adult. To analyze the methodological quality, the adapted Critical Appraisal Skill Programme (CASP) and the Agency for Healthcare and Research and Quality (AHRQ) were used. The following predictors of use of dental health services stood out: factors associated with children or adolescents (age, frequency of tooth brushing, chronic conditions), caregivers (schooling, perception of child's dental health, perceived oral health needs), dentists (availability at night and on the weekends) and follow up of oral health by the family health team. These are inherent factors for the planning of oral health policies or programs for the pediatric population. However, these factors vary according to the context, and therefore, a contextual analysis should be conducted.

Utilization of oral health services network among children and adolescents with leukemia.

AIM: To evaluate the use of the network of oral health services by children and adolescents with leukemia, according to the phase of cancer treatment, type of dental treatment received, and access barriers. METHODS AND RESULTS: An exploratory cross-sectional study carried out in a referral hospital in cancer in northeast of Brazil, with all children and adolescents (3-16 years old) with leukemia who used dental services and who attended the medical consultation in the outpatient clinic between March and August 2016. The analysis of the medical records and a structured interview with caregivers were performed. The majority who used only the specialized network were in a single phase of cancer treatment (49.1%), had oral mucositis treatment (79.2%), and had a time of displacement for oral health services greater than 40 minutes (92.6%). In addition, dental care was centered in the specialized network (76.8%) and during hospitalization (37.7%). CONCLUSIONS: The findings suggest that the oral health care of these individuals is centered on tertiary care, reflecting a deficiency in communication between the network services, as well as the nonrecognition of the basic network as a caregiver source by its users. Despite this, more research is needed.

Influence of head and linear growth on the development of malocclusion at six years of age: a cohort study

Abstract The aim of this article was to evaluate the influence of biological and sociobehavioral factors on the development of malocclusions in children. This is a cross-sectional study nested in a cohort of 350 children who participated in a community intervention study. After six years, an active search identified 290 children with occlusal abnormalities. Socioeconomic status, linear growth, and nutritional status of the child at birth and at the time of measurement, as well as dietary and sucking habits, were investigated. Malocclusions were evaluated across three spatial planes - anteroposterior, vertical, and transverse. The prevalence of these anomalies was 64.5%, primarily in the anteroposterior plane. The logistic regression analysis revealed that pacifier use for 60 months or more, stunting as measured at age six, and reduced gain in head circumference from birth to six years of age, were significantly associated with the development of malocclusion in childhood. Head circumference and linear growth are associated with occlusal anomalies in infants, independent of pacifier sucking.

Condição periodontal de crianças e adolescentes com diabetes mellitus tipo 1 no município de Recife, Pernambuco, Brasil / Periodontal status of children and adolescents with type 1 diabetes mellitus in the city of Recife, Pernambuco, Brazil

O objetivo deste estudo foi verificar a condição periodontal de crianças e adolescentes diagnosticados com Diabetes Mellitus tipo 1 e investigar sua associação com parâmetros clínicos do Diabetes, fatores socioeconômicos e variáveis relacionadas à saúde bucal. Participaram deste estudo 132 crianças e adolescentes portadores de Diabetes tipo 1 com idades variando entre 6 e 19 anos, atendidos em três hospitais da rede pública da cidade do Recife, região Nordeste do Brasil. Os participantes foram submetidos à entrevista e exames clínicos para avaliar a presença de placa bacteriana visível, sangramento gengival, profundidade de sondagem e nível de inserção clínica. Os resultados foram analisados estatisticamente pelo programa Epi-Info 6.04. A frequência de gengivite foi aproximadamente quatro vezes maior entre os que usavam insulina NPH em comparação à Lanthus. Foi observada associação estatisticamente significante entre gengivite e a renda familiar, observando-se maior frequência nos pacientes com renda abaixo de dois salários mínimos, e entre gengivite e o IPV individual, em que a presença da doença só foi observada nos indivíduos com IPV acima de 60%. Entretanto não houve associação estatisticamente significante entre a gengivite e os parâmetros clínicos do Diabetes. Não houve associação entre os parâmetros clínicos do Diabetes Mellitus tipo 1 e a gengivite, assim é possível que essa tenha sido induzida pela placa bacteriana abundante (AU).

The aim of this study was to verify the periodontal status of children and adolescents with type 1 Diabetes Mellitus and to investigate its association with clinical parameters of Diabetes, socioeconomic factors and variables related to oral health. Participants were 132 children and adolescents with type 1 Diabetes aged from 6 to 19 years, treated at three public hospitals in Recife, northeastern of Brazil. Participants underwent interviews and clinical examinations to assess the presence of visible plaque, gingival bleeding, probing depth and clinical attachment level. The results were statistically analyzed using Epi-Info 6.04.The frequency of gingivitis was approximately four times higher among those who used NPH insulin compared to Lanthus. We observed a statistically significant association between gingivitis and family income, with a higher frequency in patients with incomes below twice the minimum wage, and between gingivitis and individual VPI, in which the presence of the disease was only observed in subjects with VPI above 60%. However, there was no statistically significant association between gingivitis and clinical parameters of Diabetes. There was no association between clinical parameters of type 1 Diabetes Mellitus and gingivitis, so it is possible that this was induced by abundant plaque (AU).

Estágios curriculares de Odontologia nos serviços públicos de saúde após as Diretrizes Curriculares Nacionais de 2002 / Dentistry curricular internship in the public health services after the 2002's National Curricular Guidelines

O estágio curricular supervisionado nos serviços públicos de saúde, tal qual recomendado pelas Diretrizes Curriculares Nacionais (DCN), possibilita aos estudantes de Odontologia a proximidade com realidades e condutas profissionais diferentes daquelas que caracterizam sua rotina na prática clínica intramuros. O objetivo deste estudo foi realizar uma revisão da literatura sobre os estágios curriculares dos cursos de Odontologia nos serviços públicos de saúde brasileiros após as DCN publicadas em fevereiro de 2002 e assim estimular a reflexão sobre sua importância para a formação profissional contemporânea. Foi realizada uma revisão de literatura narrativa, baseada nos dados obtidos a partir da consulta em bases de dados (PubMed, SciELO, LILACS e Google Acadêmico), selecionando documentos publicados entre janeiro de 2010 e maio de 2017. A amostra final foi constituída por 15 publicações agrupadas nas seguintes categorias: relatos de experiência vivenciada no estágio curricular, percepção dos estudantes quanto ao estágio curricular e avaliação dos processos pedagógicos, técnicos e políticos na implantação do estágio. Conclui-se que os estágios curriculares das universidades brasileiras são espaços de aprofundamento no campo de trabalho que buscam aproximar os estudantes da realidade do sistema público de saúde, com intenção de formar profissionais humanitários, preocupados com o respeito e o cuidado da sociedade (AU).

The supervised curricular internship in the public health services, as recommended by the National Curricular Guidelines (DCN), allows dentistry leads to dentistry students the proximity to the realities and professional conduct different from those performed in their routine searching for teaching-service's health integration. The objective of this work was to conduct a review of the literature on the curricular internship in the public health service of dentistry courses of Brazilian's Higher Education Institutions after the new DCN on February 2002 and thus encourage the reflection of its value for the contemporary professional formation. A review of narrative literature was made out, based on the data obtained from the electronic databases (PubMed, SciELO, LILACS and Google Acadêmico) published between January 2010 and Mayo 2017. The final sample was consisted of 15 grouped as following: Reports of the experience lived in the Curricular Internship, students' perceptions of the curricular internship and evaluation of the pedagogical technical and political processes in the implantation of the Curricular Internship. In conclusion, the curricular internships conducted nowadays in the Brazilians Universities are points to go further in the work field, which seeks to bring students closer to the reality of the current health public system, intending to train humanitarian professionals, concerned with society's respect and care (AU).

Access to Dental Care among Adolescents with Heart Disease

Objective: To evaluate the access of adolescents aged 15 to 19 years with heart disease to oral health services at a reference hospital in the city of Recife, Brazil. Material and Methods: A cross-sectional study was conducted at the Cardiology Clinic of Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) from April to September 2015 using a convenience sample of 83 adolescents with heart disease. A questionnaire was administered in interview form to adolescents and/or parents/guardians to collect information on socio-demographic characteristics, the use of dental services and oral health habits. Data analysis was performed using descriptive statistics and association tests (chi-square test and Fisher's exact test), with the significance level set to 5% to identify possible associated factors. Results: Fifty-two adolescents (62.7%) had never been denied dental care due to their condition. Public services accounted for 66.3% of the care offered. Checkup/prevention was the main reason for seeking care (39.8%). Many of the adolescents exhibited inadequate oral hygiene habits. Forty-four (53%) did not brush their teeth regularly at night and 66 (79.5%) did not floss. No statistically significant association was found between access to dental care and social class (p=0.148), with whom the adolescent resided (p=0.607), birth order (p=0.598), race (p=0.068), education level of the head of the household (p=0.828) or scholastic failure on the part of the adolescent (p=0.196). Conclusion: Most adolescents with heart disease obtained dental care, although most did not have adequate hygiene habits. Moreover, socio-demographic, psychosocial and behavioral factors exerted no influence on access to oral health services. Further studies on this issue are needed.

Desenvolvimento da fala e alimentação infantil: possíveis implicações / Speech development and infant feeding: possible implications

RESUMO Objetivo: identificar a associação entre hábito alimentar e desenvolvimento da fala em crianças pré-escolares. Métodos: estudo do tipo caso-controle, com amostra constituída por 273 crianças matriculadas nos Centros Municipais de Educação Infantil da cidade do Recife. Foi pesquisada a associação do desfecho com variáveis referentes a características socioeconômicas, hábitos de sucção nutritiva e não nutritiva e desenvolvimento do sistema estomatognático. Foram utilizados os softwares STATA/SE 9.0 e Excel 2007 para calcular a medida de risco, OddsRatio, o intervalo de confiança de 95% e o valor de p≤0,05. Para verificar a existência de associação, aplicou-se o teste qui-quadrado para variáveis categóricas. Resultados: no que se refere às alterações de fala, verificou-se associação significante no sexo masculino. Já os hábitos de sucção não se associaram significantemente com o desfecho estudado. Com relação ao sistema estomatognático, registra-se associação significante às alterações de fala, principalmente no que concerne à postura habitual de lábios e língua, assim como com a presença de oclusopatias. Não houve associação significante entre a variável de consistência alimentar e o evento estudado. Conclusão: a consistência alimentar demonstrou associação significante com variáveis que impactam na fisiologia adequada do sistema estomatognático, em termos de órgãos fonoarticulatórios e desempenho de funções, podendo-se inferir que padrão alimentar e fala constituem ponto de convergência na saúde infantil.

ABSTRACT Purpose: to identify the association between dietary habits and speech development in preschool children. Methods: case-control study, with sample constituted of 273 children enrolled in Municipal Daycare Centers in Recife. It was researched the association of outcome with the variables related to socioeconomic characteristics, nutritive and not nutritious sucking habits and development of the stomatognathic system. We used the software STATA/SE 9.0 and Excel 2007 to calculate the risk measure, Odds Ratio with a confidence interval of 95%, plus the value of p≤0.05. To verify the existence of association, it was adopted the chi-square test for categorical variables. Results: concerning the speech disorders, it was verified significant association in males. Yet, sucking habits were not significantly associated with the outcome studied. Regarding the stomatognathic system, it was registered significant association on speech disorders, especially regarding the habitual posture of the lips and tongue, as well as the presence of malocclusion. There was no significant association between food consistency and the variable studied event. Conclusion: the food consistency demonstrated a significant association with variables that impact on the proper physiology of the stomatognathic system, in terms of phono-articulatory organs and function performance, can be inferred that eating patterns and speech constitute a convergence point in child health.

A influência de fatores sociodemográficos na ocorrência de cárie em crianças brasileiras de baixa renda / The influence of sociodemographic factors on the occurrence of caries in Brazilian children of low-income

Trata-se de um estudo transversal conduzido em uma população de 308 crianças, entre 6 e 8 anos de idade, frequentadoras de uma escola municipal de Recife/PE. Objetivou-se identificar a influência de fatores sociodemográficos, práticas alimentares e de higiene oral e acesso aos serviços de saúde bucal na gravidade da cárie dentária em crianças. Considerou-se como gravidade de cárie ceo-d maior ou igual à média encontrada na amostra estudada (ceo-d ≥ 3). A análise de regressão logística mostrou que crianças cujas mães tinham idade entre 20 e 30 anos, não receberam orientação sobre higiene bucal no pré-natal e apresentaram mais de 10 dentes afetados por cárie tiveram uma chance de 2,0 a 2,5 vezes maior de apresentar o índice ceo-d ≥ 3. As crianças que não tiveram a higiene bucal realizada após a ingestão de leite industrializado/suco/chá no primeiro ano de vida e foi referido dor/sangramento/trauma como motivo do primeiro atendimento odontológico tiveram chance de 2,0 e 3,0 vezes maior de apresentar o desfecho de interesse, respectivamente. Assim, a gravidade de cárie na população estudada mostrou-se associada à idade e experiência de cárie materna, à ocorrência de orientação sobre saúde oral do bebê durante o pré-natal, aos hábitos de higiene bucal adotados no primeiro ano de vida e ao acesso da criança aos serviços odontológicos (AU).

This is a cross-sectional study conducted in a population of 308 children aged 6 to 8 years old, attending a public school in Recife/PE that had the objective to identify the influence of sociodemographic factors, diet and oral hygiene habits, and access to oral health services in the severity of dental caries in children. Caries severity was considered as those with dmft index greater than or equal to the mean found for the studied sample (dmft ≥3). The logistic regression analysis showed that children whose mothers were aged between 20 and 30 years old, had not received oral hygiene counseling during prenatal care and had more than 10 teeth affected by caries had a chance 2.0 to 2.5 times higher to have dmft ≥3. Children who had no oral hygiene performed after drinking formula milk/juice/tea during the first year of life and was referred pain/bleeding/trauma as a reason for the first dentistry attendance had a chance 2.0 and 3.0 times higher to have the outcome of interest, respectively. Thus, the severity of caries in the studied population was associated with maternal age and caries experience, the occurrence of counseling on infant's oral health during prenatal care, oral hygiene habits adopted in the first year of life, and access to children's dental services (AU).

Cuidado dos avós com a saúde bucal de seus netos em um programa de atenção odontológica precoce / Grandparents' attention to their grandchildren's oral health in an early dental care program

Objetivos: identificar significados atribuídos pelos avós no cuidado com a saúde bucal dos netos e a condição dental destes por meio de exame clínico em um Programa de Atenção Odontológica Precoce. Métodos: estudo descritivo, exploratório e qualitativo com nove crianças acompanhadas pelos avós no ambulatório do Hospital Geral de Areias, participantes do programa "Crescendo sem Cárie". Realizou-se entrevista e exame clínico para detecção de lesões de cárie, presença de placa visível e manchas brancas por meio dos índices de cárie ceo-d e ceo-d modificado. Utilizou-se análise de conteúdo das entrevistas na modalidade temática. Resultados: os avós pertenciam à faixa etária de 38 a 77 anos. Os netos tinham idade entre 21 a 36 meses. Dois não apresentaram lesões de cárie, porém tinham manchas brancas, e sete apresentaram um índice de cárie elevado. Quatro temáticas emergiram das falas: 1. O significado do cuidado em relação à saúde bucal, 2. Avós: mães com açúcar, 3. A experiência da perda dentária no passado e 4. O conflito intergeracional interferindo na saúde bucal. Conclusões: como cuidadores dos netos no âmbito familiar, torna-se importante questionar as atitudes e os comportamentos no controle e na prevenção da cárie infantil. Atenta-se para o consumo de açúcar como transferência de amor e carinho dos avós aos netos, embora seja prejudicial à saúde bucal, conforme se comprove mediante o exame clínico.

Aim: Identify meanings attributed by grandparents' attention to their grandchildren's dental health care through clinical examination in an Early Dental Care Program. Methods: descriptive, exploratory and qualitative study with nine children accompanied by their grandparents at the Areias General Hospital participated in the "Growing up without caries" Program. It was held interviews and clinical examinations to detect caries lesions and presence of visible plaque and white spots, through caries indices ceo-d and ceo-d modified. We used content analysis of the interviews, in thematic. Results: grandparents belonged to the age group 38-77 years. The grandchildren were aged between 21 and 36 months. Two of them showed no carious lesions, however, they had white spots and seven of them showed a high caries index. Four themes emerged from the speech: 1. The meaning of care in relation to oral health, 2. Grandparents: mothers with sugar, 3. The experience of tooth loss in the past and 4. The intergenerational conflict interfering with oral health. Conclusions: as caregivers of their grandchildren in the family becomes important to question the attitudes and behaviors in the control and prevention of childhood caries. Attentive to the fact that the consumption of sugar as a transfer of love and care from grandparents to grandchildren, although detrimental to oral health, as evidenced by clinical examination.

Persistência de hábitos de sucção não nutritiva: prevalência e fatores associados / Non-nutritive sucking habits persistence: prevalence and associated factors

Identificar a prevalência de hábitos de sucção não nutritiva em pré-escolares e verificar fatores associados a sua persistência. MÉTODOS: estudo transversal e analítico realizado por meio de questionário com responsáveis de 524 crianças em 17 centros educacionais públicos de Recife/PE. Variáveis dependentes (sucção digital e de chupeta) e independentes, relacionadas à criança (sexo, idade, aleitamento materno, uso de mamadeira, enurese noturna, turnos na unidade educacional, cuidador, ordem de nascimento, visita ao dentista) e a sua mãe (escolaridade, idade, renda familiar, trabalho fora do domicilio, turnos de trabalho, coabitação, orientação sobre hábitos), foram associadas, usando os testes estatísticos qui-quadrado de Pearson, Exato de Fisher e regressão Poisson. RESULTADOS: prevalência de hábitos de sucção não nutritiva de 57 por cento: 47,5 por cento apenas sucção de chupeta. Após análise multivariada, as variáveis: tempo de aleitamento materno e uso de mamadeira continuaram associadas ao uso de chupeta, enquanto que as variáveis: escolaridade materna, uso de mamadeira, idade e sexo da criança encontraram-se fortemente associadas à sucção digital. CONCLUSÕES: alta prevalência de hábitos de sucção não nutritiva, sendo a chupeta mais frequente. Aspectos associados ao padrão de aleitamento foram apontados como principais fatores explicativos à persistência destes hábitos em pré-escolares e os aspectos psicossociais tiveram poder de associação relevante...

To identify the prevalence of nonnutritive sucking habits in preschoolers and verify factors associated with persistent habit. METHODS: a cross-sectional analytical study conducted in 17 public educational units of Recife/PE through questionnaire with 524 preschooler guardians. Dependent (digital and pacifier sucking) and independent variables, related to the children (sex, age, breastfeeding, bottle feeding, nocturnal enuresis, school period, caregiver, birth order, dentist visit) and to their mothers (schooling, age, familiar income, outside work, work shift, cohabitation, habits guidance), were associated by Pearson´s chi-square test, Fisher´s Exact test and Poisson´s regression. RESULTS: prevalence of nonnutritive sucking habits was 57 percent; 47,5 percentpacifier sucking, 5,7 percent digital sucking and 3,8 percent of both habits. After odds ratio adjustment, in a multivariate analysis, variables: breastfeeding and bottle feeding duration remained associated with pacifier sucking, while others variables as mother education, bottle feeding, and children´s age and sex were statistically significant with digital sucking. CONCLUSIONS: nonnutritive sucking habits showed high prevalence, being pacifier sucking most prevalent. Factors related to breastfeeding pattern (bottle feeding and breastfeeding duration) were explanatory factors to the habits persistence and psychosocial factors had relevant association...

Avaliação periodontal clínica e microbiológica em mães de prematuros: estudo caso-controle / Clinical and microbiological periodontal evaluation in mothers of preterm birth: case control study

Objetivo: Determinar os parâmetros clínicos periodontais e a frequência de bactérias periodontopatogênicas no biofilme subgengival de mães de prematuros comparativamente às mães de bebês a termo. Método: Foi realizado um estudo caso-controle envolvendo 40 mulheres. Foram incluídas 20 mães de prematuros no grupo caso, enquanto no grupo controle foram incluídas 20 mães de bebês a termo. Em até 48 horas após o parto, as participantes do estudo foram submetidas a uma entrevista, contendo dados de identificação, sociodemográficos, hábitos de vida, história gestacional atual e pregressa, e um exame periodontal, onde foram coletados dados de profundidade de sondagem, sangramento à sondagem, Índice de placa e perda de inserção periodontal. Na análise microbiológica do biofilme subgengival foram analisadas as bactérias Tannerella forsythia, Treponema denticola, Porphyromonas gingivalis e Aggregatibacter actinomycetemcomitans, realizada através da técnica da PCR convencional. Resultados: As médias da perda de inserção clínica e sangramento à sondagem mostraram-se significativamente superiores nas mães de bebês prematuros (p=0,049; p= 0,031, respectivamente). A Porphyromonas gingivalis mostrou-se significativamente mais frequente no grupo caso (p= 0,044). Conclusão: Sugere-se que a inflamação e perda de inserção periodontal bem como a presença da Porphyromonas gingivalis no biofilme subgengival possam estar associados à prematuridade.

Objective: The aim of this research was to determine periodontopathogens samples frequency in subgingival biofilm of pre-term delivery newborn mothers in comparison to women who experienced full-term delivery. Method: Twenty pre-term delivery newborn mothers and 20 women with full-term pregnancy were included in groups case and control, respectively. Up to forty-eight hours after the delivery, the patients were submitted to an interview, including identification, actual and late pregnancy history , life habits and a periodontal examination, which included probing depth, bleeding on probing, plaque index and clinical attachment loss. Microbiological analysis of the subgingival biofilm was carried out by conventional PCR technique to evaluate Tannerella forsythia, Treponema denticola, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Results: Clinical attachment loss and bleeding on probing means were significantly higher at case group (p=0.049; p = 0.031, respectively). Porphyromonas gingivalis was most frequent at the same group, with a significant difference (p=0.044). Periodontal disease was not associated to pre-term delivery. Conclusion: It can be suggested that periodontal tissues inflammation and the clinical attachment loss, as well as Porphyromonas gingivalis presence in subgingival biofilm may be associated to prematurity.

Periodontitis-associated risk factors in pregnant women.

OBJECTIVE: The main objective of this study was to investigate the risk factors associated with periodontitis in pregnant women. METHODS: This study was conducted in two stages. In Stage 1, a cross-sectional study was conducted to determine the prevalence of periodontitis among 810 women treated at the maternity ward of a university hospital. In Stage 2, the factors associated with periodontitis were investigated in two groups of pregnant women: 90 with periodontitis and 720 without. A hierarchized approach to the evaluation of the risk factors was used in the analysis, and the independent variables related to periodontitis were grouped into two levels: 1) socio-demographic variables; 2a) variables related to nutritional status, smoking, and number of pregnancies; and 2b) variables related to oral hygiene. Periodontitis was defined as a probing depth ≥ 4 mm and an attachment loss ≥ 3 mm at the same site in four or more teeth. A logistic regression analysis was also performed. RESULTS: The prevalence of periodontitis in this sample was 11%. The variables that remained in the final multivariate model with the hierarchized approach were schooling, family income, smoking, body mass index, and bacterial plaque. CONCLUSION: The factors identified underscore the social nature of the disease, as periodontitis was associated with socioeconomic, demographic status, and poor oral hygiene.

Periodontitis-associated risk factors in pregnant women

OBJECTIVE: The main objective of this study was to investigate the risk factors associated with periodontitis in pregnant women. METHODS: This study was conducted in two stages. In Stage 1, a cross-sectional study was conducted to determine the prevalence of periodontitis among 810 women treated at the maternity ward of a university hospital. In Stage 2, the factors associated with periodontitis were investigated in two groups of pregnant women: 90 with periodontitis and 720 without. A hierarchized approach to the evaluation of the risk factors was used in the analysis, and the independent variables related to periodontitis were grouped into two levels: 1) socio-demographic variables; 2a) variables related to nutritional status, smoking, and number of pregnancies; and 2b) variables related to oral hygiene. Periodontitis was defined as a probing depth > 4 mm and an attachment loss > 3 mm at the same site in four or more teeth. A logistic regression analysis was also performed. RESULTS: The prevalence of periodontitis in this sample was 11 percent. The variables that remained in the final multivariate model with the hierarchized approach were schooling, family income, smoking, body mass index, and bacterial plaque. CONCLUSION: The factors identified underscore the social nature of the disease, as periodontitis was associated with socioeconomic, demographic status, and poor oral hygiene.