Towards the integration of prevention and control of oral diseases within child primary healthcare: The case of Peru.

OBJECTIVES: The Peruvian public health norm of primary healthcare (PHC) for growth and development medical check-ups (CRED, Spanish acronym) of children under 5 years of age was updated in 2017 with the inclusion of interdisciplinary prevention and control actions for oral diseases, such as dentist referral. The aim of this study was to explore the association between CRED and oral health services utilization (OHSU), throughout the heterogeneous Peruvian territory. METHODS: A population-based cross sectional study was conducted using the 2021 Demographic and Family Health Survey of Peru and included data from 15 836 children aged 12-59 months. Poisson generalized linear models were used to evaluate the association between any CRED and OHSU, in the 6 months prior to the survey, including sociodemographic characteristics of the children and their mothers as confounding variables. A possible effect modification by natural region of residence (Metropolitan Lima/rest of the Coast/Highlands/Jungle) was evaluated. To examine the robustness of the regression model, a sensitivity analysis was performed using the cumulative number of CRED. RESULTS: Children who had at least one CRED were almost twice as likely to report OHSU (aPR: 1.95; 95% CI: 1.73-2.21), which was greater in the regions of rest of the Coast (aPR: 2.56; 95% CI: 2.00-3.17) and Jungle (aPR: 2.03; 95% CI: 1.64-2.56). The sensitivity analysis showed consistent results for the association CRED-OHSU. Nevertheless, within the last 6 months, attendance at CRED and OHSU were only achieved by 43.7% and 13.7% of the children respectively. CONCLUSIONS: Integrating oral health into Peruvian Child PHC seems to be a promising public health intervention to increase children's OHSU. For a greater scope, it is crucial to drive greater attendance at CRED and continuous monitoring and strengthening of CRED-based oral health promotion in all Peruvian natural regions with an equity-focused approach.

Covid-19 y la odontología latinoamericana para pacientes con necesidades especiales / Covid-19 and latin american dentistry for patients with special needs / Covid-19 and dental care for patients with special needs in Latin America

Resumen La región de América Latina se ha convertido en la más afectada del mundo por la pandemia del COVID-19. Y personas con necesidades especiales, población ya vulnerable, están sufriendo un impacto significativo de la crisis actual. Dado que estas personas no pueden dejar de ser protegidas y cuidadas, un grupo de profesores de 10 países de América Latina se reunió para analizar la situación de la odontología para pacientes con necesidades especiales en la región. En todos los países, se evidenció que el confinamiento y las restricciones de desplazamiento están interrumpiendo el acceso a bienes y servicios esenciales para ellos. En cuanto a la odontología, la disposición general es posponer los procedimientos de rutina, a menos que sean clínicamente urgentes o de emergencia; adoptar estrictas medidas de protección personal y evitar o minimizar las intervenciones que puedan producir aerosoles. La atención odontológica remota, teleodontología, se considera como una herramienta fundamental en este momento, ya que permite evaluar la necesidad de atención presencial y ofrecer soporte, información y seguridad a los pacientes y familias. La pandemia nos ha demostrado, a todos, que impulsar la Promoción de la Salud es el verdadero camino, y que no debemos esperar a que se presenten condiciones que afecten la calidad de vida.

Resumo: A região da América Latina tem se tornado a mais afetada do mundo pela pandemia do COVID-19. E as pessoas com necessidades especiais, população já vulnerável, estão sofrendo um impacto significativo da crise atual. Uma vez que essas pessoas não podem deixar de ser protegidas e cuidadas, um grupo de professores de 10 países de América Latina se reuniu para analisar a situação da odontologia para pacientes com necessidades especiais na região. Em todos os países se verificaram que o confinamento e restrições de movimento estavam interrompendo o acesso a bens e serviços essenciais para eles. Para a odontologia, a orientação geral é adiar procedimentos de rotina, a menos que seja clinicamente urgente ou emergencial; adotar medidas rígidas de proteção individual e evitar ou minimizar intervenções que possam produzir aerossóis. O atendimento odontológico à distância, teleodontología, é considerada uma ferramenta fundamental neste momento, pois permite avaliar a necessidade de atendimento presencial e oferecer suporte, informação e segurança aos pacientes e famílias. A pandemia tem demostrado, para todos, que trabalhar na Promoção da Saúde é o verdadeiro caminho, e que não devemos esperar por condições que afetem a qualidade de vida.

Abstract Latin America has become the most affected region by the COVID-19 pandemic in the world. People with special needs-an already vulnerable population-are suffering terrible consequences on account of this crisis. These people need to be protected and cared for at all times. Therefore, a group of lecturers from ten Latin American countries came together to analyze the regional situation of dental care for patients with special needs. Every country shows evidence that lockdowns and movement restrictions interrupt these people's access to essential goods and services. The general course of action regarding dental care is to postpone routine procedures unless they are clinically urgent or an emergency, implement strict personal protection measures and avoid or minimize processes that may produce aerosols. Remote dental care is considered essential these days since it allows practitioners to assess the need for face-to-face care and offer support, information, and safety to patients and families. The pandemic has shown us all that supporting health promotion is the true path and that we should not wait until conditions that affect people's quality of life appear to act.

Atención odontológica a paciente pediatrico con neurofibromatosis tipo 1: relato de caso clínico / Atendimento odontológico de uma criança com neurofibromatose tipo 1: relato de caso clínico / Dental care for a pediatric patient with neurofibromatosis type 1: a clinical case report

Resumen Este relato de caso clínico presenta a una niña de 7 años de edad, con diagnóstico de neurofibromatosis tipo 1, que fue atendida en la clínica de Odontología para Pacientes con Necesidades Especiales de la Facultad de Odontología de la UFRGS. Al examen físico se observó neurofibroma plexiforme que afectaba el párpado superior del ojo derecho, que causaba ptosis, pérdida de visión y asimetría facial. Además, manchas color café con leche y pecas en la piel. Al examen clínico bucal, se observó atresia de la arcada dentaria superior, lesiones de caries dental activas y presencia generalizada de biopelicula microbiana sobre las superfícies dentárias y sangrado gingival. Fueron realizados todos los tratamientos odontológicos necesarios para la paciente, con los cuidados pertinentes. Concluímos que es de extrema importancia que los cirujanos dentistas cuenten con conocimiento sobre la neurofibromatosis y estén preparados para formar parte de equipos transdisciplinarios en salud.

Resumo Este caso clínico apresenta uma menina de 7 anos de idade, com diagnóstico de neurofibromatose tipo 1, que foi levada à clínica de Pacientes com Necessidades Especiais do Hospital de Ensino Odontológico da Faculdade de Odontologia da UFRGS. Ao exame físico, observou-se que ela apresentava neurofibroma plexiforme acometendo a pálpebra superior do olho direito, provocando ptose, perda da visão e assimetria facial. Também apresentava manchas cor de café com leite e efélides na pele. Ao exame clínico da cavidade bucal, observou-se atresia maxilar, lesões de cárie ativas e presença generalizada de biofilme e sangramento gengival. Foram realizados os tratamentos odontológicos necessários para a paciente, com os devidos cuidados. Concluímos que é de extrema importância o conhecimento da NF1 por parte dos odontólogos e trabalhar com equipe transdisciplinar.

Abstract This clinical case report presents a 7-year-old girl diagnosed with neurofibromatosis type 1 and treated at the Dental Clinic for Patients with Special Needs of the School of Dentistry of the Federal University of Rio Grande do Sul in Brazil. The physical examination revealed a plexiform neurofibroma involving the right upper eyelid and causing ptosis, vision loss, and facial asymmetry. It also showed café-au-lait spots and freckles on the skin. The oral clinical examination showed atresia of the upper dental arch, active dental caries lesions, generalized microbial biofilm on dental surfaces, and gingival bleeding. All the necessary dental treatments were provided with the appropriate care. Dental surgeons need to have knowledge of neurofibromatosis and be prepared to participate in transdisciplinary health teams.

Prevalencia de niños víctimas de violencia en la ciudad de Porto Alegre e influencia de sus variables en el ámbito odontológico / Prevalence of children victims of violence in the city of Porto Alegre and impact of its variables on dentistry

Porto Alegre, capital del estado de Rio Grande do Sul, Brasil, es una ciudad considerada violenta. Objetivo: Evaluar características y variantes de violencia contra niños de 0 a 12 años, notificadas en la Coordinación General de Vigilancia en Salud de Porto Alegre de 2010 al 2016. Métodos: Estudio exploratorio descriptivo que analizó los datos de 6.493 casos de violencia contra niños, registrados en el SINAN y publicados en la página web de la Municipalidad de Porto Alegre. Resultados: 2015 fue el año de mayor prevalencia de violencia; 57,46% de las víctimas fueron niñas; lo tipo de violencia más frecuente fue negligencia (36,25%). La madre fue la mayor responsable de las agresiones. Conclusión: La violencia infantil es alta en Porto Alegre y para garantizar un trato adecuado de los profesionales del área de salud con niños víctimas de violencia, es necesario incluir el abordaje de estos casos en su formación académica.

Porto Alegre, capital of the state of Rio Grande do Sul, Brazil, is considered a violent city. Objective: to evaluate the main characteristics and variants of violence against children aged between 0 and 12 as reported at the General Office of Health Surveillance of Porto Alegre between 2010 and 2016. Methods: descriptive exploratory study that analyzed the data of 6,493 cases of violence against children recorded by the SINAN and published on the Porto Alegre Municipality website. Results: 2015 recorded the highest prevalence of violence against children; 57.46% of the victims were female. The most frequent type of violence was negligence (36.25%). It was the mother who was mainly responsible for the aggressions. Conclusion: Child violence is high in Porto Alegre, and to ensure that health professionals treat children victims of violence appropriately, it is necessary to address these cases in their academic education.

Relato de caso clínico: violencia doméstica contra una paciente portadora de síndrome de down / Case report: domestic violence against a patient with Down syndrome

Las mujeres con deficiencia que sufren de violencia generalmente presentan lesiones que son fácilmente visibles para los odontólogos. Cerca del 65% de las lesiones de abuso comprometen el área de cabeza, cuello o boca. Además, la tasa anual de violencia en mujeres con deficiencia es 1,7 mayor que en aquellas sin deficiencia. Dentro de este contexto, el presente trabajo descriptivo, enfocado en un caso clínico y de abordaje cualitativo, tiene como finalidad analizar los aspectos subjetivos relacionados a los sentimientos vividos por una paciente de género femenino portadora de Síndrome de Down que fue violentada en ambiente familiar. Y pretende auxiliar a Cirujanos(as) Dentistas en el sentido de que puedan garantizar las pruebas necesarias al sistema de justicia penal, con objetivo de que los derechos de las mujeres con deficiencia sean transformados en realidad. Dichos profesionales tienen la obligación moral y legal de reconocer y denunciar sospechas de violencia.

Violence against women with disabilities usually causes injuries that dentists can easily see. Approximately 65% of abuse injuries involve the head, neck or mouth areas. Additionally, women with disabilities experience violence at an annual rate 1.7 times higher than among those without disabilities. This work, which is descriptive, focuses on a clinical case and adopts a qualitative approach, and aims to analyze the subjective questions related to the feelings experienced by a female patient with Down syndrome that was the victim of violence within her family. Its objective is to help dental surgeons provide the criminal justice system with the necessary evidence so that the rights of women with disabilities are protected. These professionals have the legal and moral obligation to recognize and report suspected cases of violence.