Biosafety in Dental Health Care During the COVID-19 Pandemic: A Longitudinal Study.

Background: The coronavirus disease 2019 (COVID-19) pandemic had quite an impact on dental health care. Concerns about the risk of SARS-CoV-2 transmission through contaminant fluids and droplet formation during several dental procedures highly impacted dental health care, drastically reducing the number of dental practices worldwide. To monitor SARS-CoV-2 contamination in dental clinics, a longitudinal study was carried out during the return of dental practice at university. Methods: Dental health care professionals [(DHCPs); teachers, undergraduate dental students, and dental assistants] and patients were screened for SARS-CoV-2 RNA in a dental school clinic environment from 11th January to 12th March 2021 (9 weeks). Serological testing was performed on DHCPs in two-time points. Additionally, samples with low Ct values were sequenced to identify the circulating SARS-CoV-2 variant and possible transmission clusters. Results: We found a low number of dental staff (5.8%), patients (0.9%), and environment sites (0.8%) positive for SARS-CoV-2. Most positive cases had asymptomatic to mild symptoms, and two asymptomatic DHCPs presented prolonged infection. In the first week after previous exposure to COVID-19, 16.2% of DHCPs had IgM or IgG antibodies against SARS-CoV-2, and 1/3 of them had undetected antibodies in the last weeks. The variant zeta (P.2) could be detected. No cross-infection was observed between participants. Conclusion: Our study suggests that dental practice can be safely executed when adequate control measures and biosafety protocols are applied. DHCP and patient testing, patient telemonitoring, proper use of personal protection equipment, and sanitization of surfaces are essential to avoid SARS-CoV-2 cross-infection in dental practice.

Factors associated with oral pain and oral health-related productivity loss in the USA, National Health and Nutrition Examination Surveys (NHANES), 2015-2018.

BACKGROUND: Our aim was to identify clinical and sociodemographic factors associated with oral pain and oral health-related productivity loss among US adults. METHODS: We included adults aged ≥30 years who completed the dental examination, had at least one natural tooth, and provided an answer about their oral pain experience or oral health-related productivity loss in the 2015-2018 National Health and Nutrition and Examination Survey (NHANES). We performed descriptive analyses and multivariable binary logistic regression analyses on weighted data. RESULTS: One out of four adults had oral pain and 4% reported oral health-related productivity loss occasionally or often within the last year of the survey. The odds of oral pain were higher among non-Hispanic black (OR = 1.35; 95%CI = 1.08-1.62) and non-Hispanic Asian individuals (OR = 1.38; 95%CI = 1.07-1.78) compared to non-Hispanic white individuals, and individuals with untreated dental caries (OR = 2.06; 95%CI = 1.72-2.47). The odds for oral health-related productivity loss were 13.85 times higher among individuals who reported oral pain (95%CI = 8.07-23.77), and 2.18 times higher among individuals with untreated dental caries (95%CI = 1.65-2.89). The odds of oral pain and reported oral health-related productivity loss decreased as family income increased. CONCLUSIONS: Factors including non-Hispanic black race/ethnicity, lower socio-economic status, and untreated dental caries are associated with oral pain experience, which increases the odds of oral health-related productivity losses. Identifying factors associated with oral pain and productivity loss will enable clinicians, policymakers, and employers to proactively target and prioritize the higher-risk groups in early interventions and policies.

Association of sociodemographic factors with the prescription pattern of opioids for dental patients: A systematic review protocol.

INTRODUCTION: Oral health practitioners are responsible for a significant share of opioid prescriptions that seem to be influenced by many aspects, including sociodemographic factors. However, there is no consensus on the factors associated with opioid prescription in Dentistry. OBJECTIVE: To identify whether patients' sociodemographic factors are associated with the prescription pattern of opioids in Dentistry. MATERIALS AND METHODS: This systematic review will include observational studies (cross-sectional, case-control, and cohort). Electronic searches will be conducted in MEDLINE (PubMed), EMBASE, Scopus, Web of science, LILACS, SciELO, and Google Scholar. Grey literature will also be consulted. Two independent reviewers will screen all retrieved articles for eligibility, extract data, and assess the methodological quality of the included studies. The results will be presented as a narrative synthesis and, where possible, a meta-analysis will be conducted. Certainty of the evidence will be assessed with the Grading of Recommendations, Assessment, Development, and Evaluation approach. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020211226.

Factors associated with the performance of primary dental health care in Brazil: A multilevel approach.

This study evaluated the factors associated with the performance of Brazilian Oral Health Teams (OHTs).This is multilevel research that used data from 12,386 Brazilian OHTs in 2012. The OHTs performance was estimated in previous research by using Item Response Theory model, which employed 20 questions about dental procedures in Primary Care. The first level covariates were based on OHTs procedures such as: the record of pregnant woman dental appointment, provision of dentistry home care, dental appointments scheduled choices, and OHTs in charge for more than 5000 individuals. Moreover, the use of guidelines was accessed concerning delivering prostheses in primary care, referring to secondary care, referring to suspected oral cancer, and providing care towards patients with special needs. Variables included in level 2 were GINI and Human Development Index. Multilevel linear regression models were constructed, estimating linear regression coefficients, 95% confidence intervals, and P values.OHTs performance was different among the 3,613 municipalities analyzed (P < .001), with 36.7% of the variation in the performance of the OHTs being attributed to the variability between municipalities. The adjusted model showed that higher performance OHTs reported attention to pregnant women, dentistry home care and use of dental care guidelines (P < .001). There were lower performance scores for those OHTs with more restricted scheduling (P < .05), compared to those that reported scheduling appointments at any day and time. The best OHTs and population ratio led to a better performance score (P = .010). At the municipal level, better socioeconomic status was associated with better performance of the OHTs (P < .001).OHTs with higher performance are associated with oral health services organizations and municipalities' socioeconomic status.

What Has Changed in the Dental Prosthesis Procedures in Primary Health Care In Brazil?

The study aimed to identify the changes in the provision of dental prosthetics procedures in the Brazilian primary care. Secondary data from the Brazilian "National Programme for Improving Access and Quality of Primary Care" was assessed and three similar questions related to dental prostheses execution that were answered by the same 9,698 oral health teams, in 2011/2012 and 2013/2014, were compared. There was a 4.3% increase in the number of teams that identified individuals with prosthetic needs; a 0.8% increase in the number of teams that performed impression for prosthetic purposes; and the number of teams that reported performing dental prostheses consultations increased by 0.6%. Overall, there was a small modification in the number of teams that provided dental prosthesis procedures in Brazil.

Perfil dos cirurgiões-dentistas e sua influência sobre o desempenho das equipes de saúde bucal atuantes no Sistema Único de Saúde brasileiro / Dentists profile and its influence in the performance of dental teams of the Brazilian National Health System

O objetivo deste estudo foi avaliar a influência do perfil dos cirurgiões-dentistas e da organização e planejamento dos serviços de saúde bucal no desempenho das Equipes de Saúde Bucal (ESB) atuantes na Atenção Primária em Saúde (APS) brasileira. Trata-se de um estudo transversal, utilizando dados secundários do segundo ciclo do 'Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica' (PMAQ-AB), ocorrido entre 2013 e 2014. Foram utilizados dados obtidos na fase de avaliação externa do PMAQ-AB, que envolveu entrevista com 18.114 dentistas sobre o processo de trabalho das equipes e verificação de documentos na Unidade Básica de Saúde. O questionário foi desenvolvido por meio de uma parceria do Ministério da Saúde com seis instituições de ensino e pesquisa, sendo aplicado por equipe treinada. A variável dependente, 'desempenho das ESB', foi um escore atribuído a cada ESB, estimado por Teoria de Resposta ao Item, através da análise psicométrica de 20 procedimentos odontológicos da APS. As variáveis independentes incluíram características de formação, vínculo de trabalho e plano de carreira dos cirurgiões dentistas, bem como dados referentes à gestão e organização dos serviços de saúde bucal. Análises de Regressão Linear foram realizadas para estimativa dos valores de Beta brutos e ajustados, bem como respectivos intervalos de confiança no modelo ajustado (IC95%). Foram consideradas estatisticamente significativas as variáveis com p≤0,05. Os resultados indicaram que os procedimentos com maiores níveis de dificuldade (e menos frequentemente realizados) foram aqueles relacionados à provisão de próteses dentárias e monitoramento do câncer de boca; os procedimentos com maior capacidade de discriminação foram restauração e exodontia de dentes decíduos. O desempenho das ESB variou de -3,66 a +1,87 (média -0,06; DP 0,82). As variáveis 'pós-graduação Lato Sensu', 'atividades de educação permanente', 'monitoramento e análise dos indicadores e informações de saúde bucal' e 'agenda de atendimentos flexível (usuários agendados e de demanda espontânea)' influenciaram de forma positiva o desempenho de ESB em todas as macrorregiões brasileiras. Variações na realização de procedimentos odontológicos da APS, nos escores de desempenho das ESB e nas variáveis que influenciaram tais desempenhos puderam ser observadas entre as cinco macrorregiões brasileiras. Os achados indicam que a formação complementar do cirurgião-dentista, no formato de educação permanente e pós-graduação Lato Sensu, a avaliação de indicadores de saúde bucal da população adscrita e a oferta de agenda de atendimentos flexível, garantindo atendimento às demandas espontâneas e programadas dos usuários, foram de grande importância para um bom desempenho das equipes de saúde bucal brasileiras atuantes no SUS. (AU)

This study aimed to evaluate the influence of dentists' profile and work management in the performance of primary care dental teams of the Brazilian National Health System. Cross-sectional analysis of secondary data from the 'National Programme for Improving the Access and Quality of Primary Care' (PMAQ-AB), that evaluated 18,114 Brazilian dental teams between 2013 and 2014. Data were obtained from the external evaluation phase of the PMAQ-AB, which comprised the interview with the dentist regarding the dental team's work process and verification of documents in the primary health care units. The questionnaire was developed through a partnership between the Ministry of Health and six teaching and research institutions and was applied by trained professionals. The dependent variable, 'performance of dental teams', was a score of dental teams obtained from the Item Response Theory, estimated though the psychometric analysis of 20 dental procedures executed in the PHC. Independent variables included complementary training, employment relationship and career plan of dentists and data referring to the management and organization of oral health services. Linear Regressions were performed to estimate the raw and adjusted Beta values, as well as their confidence intervals (CI 95%); in the adjusted model, variables with p≤0.05 were considered statistically significant. The results showed that the procedures with the highest difficulty levels (and less frequently performed) were those related to the provision of dental prostheses and oral cancer monitoring; the most discriminating procedures were restoration and extraction of primary teeth. The dental teams' performance ranged from -3.66 to +1.87 (mean -0.06; SD 0.82). The variables 'graduate studies', 'continuing education activities ', 'monitoring oral health indicators' and 'flexible dental appointment list (scheduled and walk in patients)' influenced the dental teams' performance in all Brazilian Geographical Regions. Variations in the execution of PHC dental procedures, dental teams' performance scores, and the variables that influenced such performances could be observed among the five Brazilian Geographical Regions. The findings suggest that the complementary training of the dentist, including continuing education training and graduate studies, the evaluation of oral health indicators of the enrolled population and the offer of a flexible appointment list, ensuring care to scheduled and walk in patients, had a positive impact in the performance of Brazilian dental teams. (AU)

Exodontias no Sistema Único de Saúde em Minas Gerais: uma série temporal de 15 anos / Tooth extraction in the Brazilian Health System, Minas Gerais state: a 15-year time-series

Objetivo: Avaliar a tendência histórica de extrações dentárias no Estado de Minas Gerais entre os anos de 1998 e 2012. Métodos: Trata-se de um estudo de série temporal de exodontias de dentes permanentes no Estado de Minas Gerais, tendo sido os dados coletados no Sistema de Informações Ambulatoriais do Sistema Único de Saúde em 2013. Duas taxas de exodontias foram calculadas, ano a ano. A primeira refere-se à razão entre número total de exodontias de dentes permanentes dividida por todos os procedimentos preventivos, restauradores e cirúrgicos da atenção primária. A segunda foi a razão entre o número total de exodontias de dentes permanentes pelo número de habitantes. A análise estatística envolveu a construção de curvas de tendência histórica. Resultados: As duas taxas de exodontias comportaram-se de maneira errática no período avaliado. Houve uma ligeira tendência de aumento na taxa de exodontias por procedimentos da atenção primária e ligeira tendência de redução na taxa de exodontias pela população do Estado de Minas Gerais. Conclusão: As ligeiras tendências de aumento ou redução das taxas de exodontias revelam que as mesmas permaneceram constantes no período avaliado no Estado de Minas Gerais.(AU)

Aim: To evaluate the time-series of permanent tooth extraction in the state of Minas Gerais between the years 1998 and 2012. Methods: This is a timeseries study of permanent tooth extraction in the state of Minas Gerais. Data were collected in the Brazilian National Health Information System in 2013. Two annual rates of tooth extraction were calculated. The first was the ratio of the extractions of permanent teeth in relation to the total number of individual dental procedures in primary care. The second was the ratio of the number of extractions of permanent teeth divided by the total population. The statistical analysis of the time series was performed. Results: The two extractions rates behaved erratically during the study period. There was a slight tendency to increase in tooth extraction rate via primary care procedures and slight downward trend in tooth extraction rate in Minas Gerais state population. Conclusions: The slightly tendency in increase or decrease of the tooth extraction rates reveal that they remained constant in this period in the state of Minas Gerais.(AU)

Percepções sobre a saúde bucal e o atendimento odontológico entre sujeitos em processo de transplante de células tronco hematopoiéticas / Perceptions of oral health and dental care among subjects under hematopoietic stem cell transplantation

O presente estudo objetivou conhecer e avaliar as percepções sobre saúde bucal e cuidado odontológico entre pessoas transplantadas de células tronco hematopoiéticas. Foram realizadas entrevistas semiestruturadas e individuais com indivíduos na fase pós transplante de células tronco hematopoiéticas, de ambos os sexos e maiores de dezoito anos que realizavam tratamento odontológico na Faculdade de Odontologia da Universidade Federal de Minas Gerais entre o segundo semestre de 2014 e o primeiro semestre de 2015. Todas as entrevistas foram gravadas e transcritas por um mesmo pesquisador, respeitando a grafia e sintaxe utilizadas pelos entrevistados. A análise das entrevistas foi baseada na análise de conteúdo temática e três temas foram avaliados: o que é saúde bucal, por que o tratamento odontológico pré-transplante foi realizado e qual a importância do tratamento odontológico para o transplante de células tronco hematopoiéticas. A saúde bucal é percebida como o ato de cuidar dos dentes por meio das normas de higiene bucal. O motivo da realização do tratamento odontológico prévio envolve exigências normativas para o transplante e, quando questionados sobre a importância do tratamento odontológico para o transplante o discurso dos entrevistados abarca a prevenção de infecções durante a fase de baixa imunidade. Observa-se que os indivíduos veem o tratamento odontológico como uma etapa a ser seguida antes do transplante e que sua preocupação principal não seria reestabelecer sua saúde bucal e sim, terminar o tratamento o quanto antes for possível

This study aimed to know and evaluate the perception about oral health and oral health care among patients submitted to hematopoietic stem cells transplantation. Semistructured individual interviews were conducted with individuals in the post-transplant phase of hematopoietic stem cells, of both genders and over 18 years old that were undergoing treatment at dentistry school of Universidade Federal de Minas Gerais, between the second semester of 2014 and the first semester of 2015. All interviews were recorded and transcribed by a same researcher, maintaining the spelling and syntax used by respondents. The data analysis was based on content analysis and three topics were evaluated: what oral health is, why pre-transplant dental treatment was performed and the importance of dental treatment for the transplant of hematopoietic stem cells. Oral health is perceived as the act of taking care of teeth through oral hygiene procedures. The reason for the oral care involves regulatory requirements for transplantation, and when asked about the importance of dental treatment for transplant, interviewed focus on the prevention of infections during the period of low immunity. It is observed that individuals see dental treatment as a step to be followed before the transplant and that their main concern was not a better oral health but, instead to complete the treatment as soon as possible