Práticas Integrativas e Complementares em Saúde: a construção (in)completa da política em um município de grande porte no Brasil / Integrative and Complementary Practices in Health: the (in)complete construction of the policy in a large city in Brazil

RESUMO Objetiva-se analisar o processo de implantação, situação atual e perspectivas do Programa de Homeopatia, Acupuntura e Medicina Antroposófica (PRHOAMA) da rede pública de saúde de Belo Horizonte (Brasil) segundo as diretrizes da Política Nacional de Práticas Integrativas e Complementares (PNPIC). Realizou-se estudo de caso por meio de análise documental de 32 textos oficiais; dados secundários obtidos pelo número de profissionais e procedimentos ofertados em sistemas de informação em saúde; e realização de um grupo focal com profissionais do PRHOAMA. O programa foi implantado em 1994 nas Unidades Básicas de Saúde (UBS), configurando-se uma experiência pioneira no Brasil. As práticas são realizadas exclusivamente por médicos, o que diverge das recomendações da PNPIC, cujo modelo preconizado é o multiprofissional. O processo de institucionalização do PRHOAMA é parcial, não se configurando uma política pública consolidada. O PRHOAMA atende às diretrizes da PNPIC, tais como ênfase na Atenção Primária, divulgação e informação sobre as Práticas Integrativas e Complementares em Saúde (Pics). Entretanto, é necessário avançar na promoção do acesso aos medicamentos homeopáticos, na definição de mecanismos de financiamento e na ampliação da equipe gestora e de profissionais.

ABSTRACT The objective of this study was to analyze the process of implementation, the current situation and perspectives of the Homeopathy, Acupuncture and Anthroposophical Medicine Program (PRHOAMA) in public health service in Belo Horizonte (Brazil) considering the guidelines of the National Policy for Integrative and Complementary Practices (PNPIC). The case study was carried out through document analysis of 32 official texts, secondary data (number of professionals and procedures offered) in health information systems and a focus group with professionals of PRHOAMA. The program was implemented in 1994, in Basic Health Units (UBS), configuring itself as a pioneering experience in Brazil. Practices are performed exclusively by physicians, which diverges from the recommendations of the PNPIC, whose recommended the ideal model is multi-professional. PRHOAMA's institutionalization process is partial, not constituting a consolidated public policy. PRHOAMA complies with the PNPIC guidelines, such as emphasis on Primary Care, dissemination and information about Complementary Therapies. However, it is necessary to advance in the promotion of access to homeopathic medicines, in the definition of financing mechanisms and in the expansion of the management team and professionals.

Self-reported oral health among Brazilian adults: results from the National Health Surveys 2013 and 2019. / Condições de saúde bucal autorrelatadas entre adultos brasileiros: resultados das Pesquisas Nacionais de Saúde de 2013 e 2019.

OBJECTIVE: To evaluate indicators of oral health conditions and behaviours among Brazilian adults in the 2019 National Health Survey (PNS) and analyse the evolution of those indicators compared to the 2013 PNS. METHODS: Cross-sectional study. Prevalence ratios of oral health conditions and behaviours, in 2019, were estimated by demographic characteristics. Risk ratios were computed using Poisson regression, and absolute differences (Dif.) between indicators in 2013 and 2019 were calculated. RESULTS: Prevalence of brushing teeth twice a day, using toothbrush/toothpaste/floss and edentulism were, respectively, 93.6% (95%CI 93.3;93.9), 63.0% (95%CI 62.3;63.6) and 10.3% (95%CI 9.93;10.7). There was increase in prevalence of brushing teeth ≥ 2 a day (Dif. = 4.5; 95%CI 3.9;5.1), using toothbrush/toothpaste/floss (Dif. = 10.0; 95%CI 8.6;11.3) and a decrease in prevalence of edentulism (Dif. = -0.7; 95%CI -1.3;-0.1). CONCLUSION: Respondents who were younger, more educated, with higher income and lived in urban areas had better oral health indicators. Most indicators demonstrated positive improvement.

Mother's education and family relations protect children from dental caries experience: a salutogenic approach.

The objective of this study was to identify dental caries-protective factors among 5-year-old children using the salutogenic theory. A cross-sectional study was conducted in a small-sized municipality in the Southeast region of Brazil, with a representative sample of 247 children registered in preschool and their respective mothers. The data were collected through questionnaires administered to the mothers about the socioeconomic, behavioral, and biological aspects of the mother and children. Additionally, the collections included validated instruments concerning psychosocial aspects, such as a sense of coherence, resilience, family cohesion and religiosity, and intraoral examinations of the children through the decayed-missing-filled primary teeth (dmft) index. All examinations were performed by a trained and calibrated examiner. The non-adjusted and adjusted odds ratios (OR) and their respective confidence intervals (CI) were estimated using multiple logistic regression with a hierarchical model. Among the examined children, 41.7% were caries-free. In the final model, the chances of the absence of dental caries experience (dmft = 0) were greater in children with mothers who had higher education levels (> 8 years of study) (OR = 2.55 [95%CIi:1.42-4.59]) and those who lived in an environment of high family cohesion (OR = 3.66 [95%CI: 1.19-11.29]). The results indicated that mothers' level of education and family relationships are protective factors against dental caries in 5-year-old children, which overlapped with behavioral and biological factors.

The influence of protective psychosocial factors on the incidence of dental pain.

OBJECTIVE: To investigate the influence of protective psychosocial factors on the incidence of dental pain in the last six months among 12-year-old children living in Manaus (AM). METHODS: A prospective school-based cohort study was conducted with 210 12-year-old students enrolled in public schools in the eastern zone of Manaus (AM). Students were followed up for two years. Validated questionnaires were used to assess sociodemographic characteristics, protective psychosocial factors, including sense of coherence, social support, and self-esteem at baseline and after two years. Calibrated examiners clinically assessed dental caries and gingival bleeding. Multivariate multilevel Poisson regression was used to estimate the relative risk (RR) and 95% confidence interval (95%CI) between the changes on psychosocial factors scores and incidence of dental pain, adjusted for psychosocial factors scores at baseline, dental health insurance, frequency of tooth brushing, and dental caries. RESULTS: Mean scores for sense of coherence and social support reduced significantly from baseline to 2-year follow-up. The incidence of dental pain along the two-year follow-up was 28.6%. The risk of dental pain was 14% higher for every 10 points in the mean reduction of sense of coherence score (RR = 1.14; 95%CI: 1.02-1.20), and 6% higher for every 10 points of the mean reduction in social support score (RR = 1.06; 95%CI: 1.01-1.11). Change on self-esteem was not associated with risk of dental pain. CONCLUSION: Change on sense of coherence and social support over the two-year period influenced the incidence of dental pain among children, suggesting that protective psychosocial factors, health behaviours, dental health insurance, and clinical oral condition have an important role in the incidence of dental pain.

Mother's education and family relations protect children from dental caries experience: a salutogenic approach

Abstract The objective of this study was to identify dental caries-protective factors among 5-year-old children using the salutogenic theory. A cross-sectional study was conducted in a small-sized municipality in the Southeast region of Brazil, with a representative sample of 247 children registered in preschool and their respective mothers. The data were collected through questionnaires administered to the mothers about the socioeconomic, behavioral, and biological aspects of the mother and children. Additionally, the collections included validated instruments concerning psychosocial aspects, such as a sense of coherence, resilience, family cohesion and religiosity, and intraoral examinations of the children through the decayed-missing-filled primary teeth (dmft) index. All examinations were performed by a trained and calibrated examiner. The non-adjusted and adjusted odds ratios (OR) and their respective confidence intervals (CI) were estimated using multiple logistic regression with a hierarchical model. Among the examined children, 41.7% were caries-free. In the final model, the chances of the absence of dental caries experience (dmft = 0) were greater in children with mothers who had higher education levels (> 8 years of study) (OR = 2.55 [95%CIi:1.42-4.59]) and those who lived in an environment of high family cohesion (OR = 3.66 [95%CI: 1.19-11.29]). The results indicated that mothers' level of education and family relationships are protective factors against dental caries in 5-year-old children, which overlapped with behavioral and biological factors.

Condições de saúde bucal autorrelatadas entre adultos brasileiros: resultados das Pesquisas Nacionais de Saúde de 2013 e 2019 / Condiciones de salud bucal autoinformadas en brasileños adultos: resultados de las Encuestas Nacionales de Salud 2013 y 2019 / Self-reported oral health among Brazilian adults: results from the National Health Surveys 2013 and 2019

Objetivo: Analisar indicadores das condições e comportamentos relacionados à saúde bucal de brasileiros adultos na Pesquisa Nacional de Saúde (PNS) 2019 e sua evolução em relação a 2013. Métodos: Estudo transversal que estimou prevalências de comportamentos e condições de saúde bucal segundo variáveis demográficas. Foram calculadas as razões de prevalência, por regressão de Poisson, e estimadas diferenças absolutas (Dif.) entre os indicadores de 2013 e 2019. Resultados: Em 2019, as prevalências de escovação ≥ 2 vezes ao dia, uso de escova/dentifrício/fio dental e edentulismo foram, respectivamente, 93,6% (IC95% 93,3;93,9), 63,0% (IC95% 62,3;63,6) e 10,3% (IC95% 9,9;10,7). Escovação ≥ 2 vezes/dia (Dif. = 4,5; IC95% 3,9;5,1) e uso de escova/dentifrício/fio dental (Dif. = 10,0; IC95% 8,6;11,3) aumentaram, enquanto o edentulismo (Dif. = -0,7; IC95% -1,3;-0,1) foi reduzido. Conclusão: Observaram-se melhores indicadores de saúde bucal entre pessoas mais jovens, com ensino superior, maior renda e residentes na zona urbana. Verificou-se melhoria na maioria dos indicadores estudados.

Objetivo: Evaluar los indicadores de salud bucal en la población brasileña adulta en base a los datos de la Encuesta Nacional de Salud (PNS) 2019, y analizar su evolución en relación a PNS 2013. Métodos: Se trata de un estudio transversal. Se estimó la prevalencia de conductas y condiciones de salud bucal en 2019, según características sociodemográficas. Se calcularon razones de prevalencia con regresión de Poisson y se estimaron las diferencias (Dif.) entre los indicadores de 2013 y 2019. Resultados: La prevalencia de cepillado ≥ 2 veces al día, uso de cepillo/pasta/hilo dental y edentulismo ha sido, respectivamente, 93,6% (IC95% 93,3;93,9), 63,0% (IC95% 62,3;63,6) y 10,3% (IC95% 9,93;10,7). Prevalencia de cepillado ≥ 2 veces al día (Dif. = 4,5; IC95% 3,9;5,1) y uso de cepillo/pasta/hilo dental (Dif. = 10,0; IC95% 8,6;11,3) aumentó, mientras que el edentulismo (Dif. = -0,7; IC95% -1,3; -0,1) disminuyó. Conclusión: Se observaron mejores indicadores entre jóvenes, con educación superior, mayores ingresos y en áreas urbanas. Hubo mejora en la mayoría de los indicadores.

Objective: To evaluate indicators of oral health conditions and behaviours among Brazilian adults in the 2019 National Health Survey (PNS) and analyse the evolution of those indicators compared to the 2013 PNS. Methods: Cross-sectional study. Prevalence ratios of oral health conditions and behaviours, in 2019, were estimated by demographic characteristics. Risk ratios were computed using Poisson regression, and absolute differences (Dif.) between indicators in 2013 and 2019 were calculated. Results: Prevalence of brushing teeth twice a day, using toothbrush/toothpaste/floss and edentulism were, respectively, 93.6% (95%CI 93.3;93.9), 63.0% (95%CI 62.3;63.6) and 10.3% (95%CI 9.93;10.7). There was increase in prevalence of brushing teeth ≥ 2 a day (Dif. = 4.5; 95%CI 3.9;5.1), using toothbrush/toothpaste/floss (Dif. = 10.0; 95%CI 8.6;11.3) and a decrease in prevalence of edentulism (Dif. = -0.7; 95%CI -1.3;-0.1). Conclusion: Respondents who were younger, more educated, with higher income and lived in urban areas had better oral health indicators. Most indicators demonstrated positive improvement.

The influence of protective psychosocial factors on the incidence of dental pain / A influência de fatores psicossociais protetores sobre a incidência de dor dentária

ABSTRACT OBJECTIVE To investigate the influence of protective psychosocial factors on the incidence of dental pain in the last six months among 12-year-old children living in Manaus (AM). METHODS A prospective school-based cohort study was conducted with 210 12-year-old students enrolled in public schools in the eastern zone of Manaus (AM). Students were followed up for two years. Validated questionnaires were used to assess sociodemographic characteristics, protective psychosocial factors, including sense of coherence, social support, and self-esteem at baseline and after two years. Calibrated examiners clinically assessed dental caries and gingival bleeding. Multivariate multilevel Poisson regression was used to estimate the relative risk (RR) and 95% confidence interval (95%CI) between the changes on psychosocial factors scores and incidence of dental pain, adjusted for psychosocial factors scores at baseline, dental health insurance, frequency of tooth brushing, and dental caries. RESULTS Mean scores for sense of coherence and social support reduced significantly from baseline to 2-year follow-up. The incidence of dental pain along the two-year follow-up was 28.6%. The risk of dental pain was 14% higher for every 10 points in the mean reduction of sense of coherence score (RR = 1.14; 95%CI: 1.02-1.20), and 6% higher for every 10 points of the mean reduction in social support score (RR = 1.06; 95%CI: 1.01-1.11). Change on self-esteem was not associated with risk of dental pain. CONCLUSION Change on sense of coherence and social support over the two-year period influenced the incidence of dental pain among children, suggesting that protective psychosocial factors, health behaviours, dental health insurance, and clinical oral condition have an important role in the incidence of dental pain.

RESUMO OBJETIVO Investigar a influência de fatores psicossociais protetores sobre a incidência de dor dentária nos últimos seis meses em crianças de 12 anos residentes em Manaus (AM). MÉTODOS Um estudo de coorte prospectivo de base escolar foi realizado com 210 alunos de 12 anos, matriculados em escolas públicas da zona leste de Manaus (AM) que foram acompanhados por dois anos. Questionários validados foram usados para avaliar características sociodemográficas, fatores psicossociais protetores, incluindo senso de coerência, apoio social e autoestima na linha de base e após dois anos. Examinadores calibrados avaliaram clinicamente cárie dentária e sangramento gengival. Regressão de Poisson multinível multivariada foi usada para estimar o risco relativo (RR) e o intervalo de confiança de 95% (IC95%) entre a variação dos escores dos fatores psicossociais e a incidência de dor dentária, ajustada para os escores dos fatores psicossociais na linha de base, plano de saúde odontológico, frequência de escovação dentária e cárie dentária. RESULTADOS As médias dos escores do senso de coerência e do apoio social reduziram significativamente entre linha de base e seguimento de dois anos. A incidência de dor dentária no seguimento de dois anos foi 28,6%. O risco de dor dentária foi 14% maior para cada 10 pontos na redução média do escore do senso de coerência (RR = 1,14; IC95% 1,02-1,20), e 6% maior para cada 10 pontos na redução média do escore do apoio social (RR = 1,06; IC95% 1,01-1,11). A mudança na autoestima não foi associada ao risco de dor dentária. CONCLUSÃO A variação do senso de coerência e do apoio social no período de dois anos influenciou a incidência de dor dentária em crianças, sugerindo que fatores psicossociais protetores, comportamentos em saúde, plano odontológico e a condição clínica bucal desempenham um papel importante na incidência da dor dentária.

Oral health work process: disparity between teams in Brazil, 2014. / Processo de trabalho em saúde bucal: disparidade entre as equipes no Brasil, 2014.

OBJECTIVE: To compare Modality I and Modality II Oral Health Teams (OHT) regarding work process performance and differences between Brazilian regions. METHODS: This was a cross-sectional study with OHTs that took part in the National Program for Primary Health Care Access and Quality Improvement (2013-2014). Latent Class Analysis identified OHT subgroups according to work process (action planning, health promotion actions and comprehensive health care) performance (consolidated, developing or incipient). OHT modalities were compared, resulting in an Index of Disparity. RESULTS: After evaluating 15,886 OHTs, Modality II OHTs were found to have a higher percentage of consolidated work processes in the Southeast (67.8%-94.6%) and Southern (54.8%-93.0%) regions. Disparity in the consolidated work process was greater among Modality II OHTs (6.3-26.5) compared to Modality I OHTs (3.9-18.4). CONCLUSION: Modality II OHTs have the potential for better performance regarding the work process, but with regional disparities.

Systematic Review on the Use of Homeopathy in Dentistry: Critical Analysis of Clinical Trials.

Objectives: The objective of this research was to systematically map the literature on homeopathy and dentistry studies and to evaluate the effectiveness of using homeopathy in dental practice through the critical analysis of clinical studies. Design: The search for scientific articles in any language, year, and place of publication was made in the databases of Public Medline (PUBMED), Web of Science, Cochrane, and Virtual Health Library; the articles selected were later classified according to the type of study. Gray literature was accessed through Google Scholar. Clinical trials were analyzed for methodological quality. Two previously trained reviewers accomplished the entire process independently. Results: Of the 281 studies retrieved by means of the search, 44 met the eligibility criteria, with prevalence of literature reviews (56.8%), followed by clinical trials (34.1%), cross-sectional studies (6.8%), laboratory research (6.8%), and longitudinal observational studies (4.5%). The clinical trials identified were published from 1965 to 2019, using homeopathy in several dental specialties: in Endodontics, Periodontics, Orofacial Pain, Surgery, Pediatric Dentistry, and Stomatology, as well as in cases of dental anxiety. Qualitative failures, in all criteria investigated, and positive influences of the individual prescriptions on the results of treatments reported were observed. Conclusions: There is still a scarcity of studies about homeopathy and dentistry. The clinical trials selected showed positive effects on oral health; however, when they were critically evaluated, it was possible to recognize qualitative failures, mainly relative to double-blinding. It is necessary to encourage research on the subject, using standardized methodological procedures, to obtain better evaluation of the clinical applicability.

Estudo transversal do autorrelato de bruxismo e sua associação com estresse e ansiedade / Cross-sectional study about self-reported bruxism and its association with stress and anxiety

Resumo Introdução O bruxismo é uma condição prevalente e pode ser destrutivo à cavidade bucal, sendo amplamente abordado na Odontologia, especialmente por sua etiologia multifatorial e prevalência controversa. Objetivo Este estudo teve o objetivo de investigar a prevalência do autorrelato de bruxismo entre universitários e correlacionar a parafunção com a ansiedade e o estresse autopercebidos Material e método Utilizaram-se o autorrelato de bruxismo, Inventário de Ansiedade Traço-Estado (IDATE) e Inventário de Sintomas de Estresse de LIPP (LIPP) para avaliar a prevalência de bruxismo, ansiedade e estresse, respectivamente. Setecentos e quatorze estudantes de todos os cursos da universidade foram entrevistados, com idade entre 18 e 45 anos. Análises estatísticas descritivas foram realizadas por cálculos de frequências (absolutas e relativas), bem como medidas de tendência central e dispersão (média e desvio padrão). Quanto às análises estatísticas inferenciais, o teste qui-quadrado ou exato de Fisher foi utilizado na comparação de proporções e o teste t de Student ou ANOVA, como critério para comparar médias, todos com nível de significância de 5%. Resultado A prevalência de bruxismo foi 46,92%; houve diferença significante da proporão do bruxismo com a ansiedade estado (p = 0,00) e traço (p ≤ 0,0001) de personalidade. Conclusão Conclui-se que, apesar de o bruxismo não ter prevalecido entre estudantes, um elevado percentual de estudantes afirmou realizar essa atividade repetitiva e a proporção de bruxistas com ansiedade foi relevante, evidenciando a importância desse fator psicológico na fisiopatologia da parafunção.

Abstract Introduction Bruxism is a prevalent condition and can be destructive to the oral cavity, being widely addressed in dentistry, especially due to its multifactorial etiology and controversial prevalence. Objective This study aimed to investigate the prevalence of self-reported bruxism among university students and to correlate it with self-perceived anxiety and stress. Material and method Self-reported Bruxism, Trait-State Anxiety Inventory (STAI) and LIPP Stress Symptoms Inventory (LIPP) were used to assess the prevalence of bruxism, anxiety and stress, respectively. 714 students of all courses of a university were interviewed, they were between 18 and 45 years. Descriptive statistical analyzes performed by calculations of frequencies (absolute and relative), as well as measures of central tendency and dispersion (mean and standard deviation). About inferential statistical analyzes, the Chi-square or Fisher's exact test was used to compare proportions and the Student t test or ANOVA was a criterion for comparing means, all with a 5% significance level. Result The prevalence for bruxism was 46.92%; there was a significant difference in the proportion of bruxism with state anxiety (p = 0.00) and personality trait (p = <0.0001). Conclusion It is concluded that although bruxism did not prevail among students, a high percentage of students stated to perform this repetitive activity and the proportion of bruxists with anxiety was relevant, showing the importance of this psychological factor in the pathophysiology of parafunction.

Processo de trabalho em saúde bucal: disparidade entre as equipes no Brasil, 2014 / Proceso de trabajo de salud bucal: disparidad entre equipos en Brasil, 2014 / Oral health work process: disparity between teams in Brazil, 2014

Objetivo: Comparar o desempenho das equipes de saúde bucal (ESBs) das modalidades I e II no processo de trabalho e as diferenças entre regiões brasileiras. Métodos: Estudo transversal, com dados das ESBs que aderiram ao Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (2013-2014). A análise de classes latentes identificou subgrupos de ESBs segundo desempenho (consolidado, em desenvolvimento ou incipiente) no processo de trabalho (planejamento das ações; promoção da saúde; atenção integral). Comparadas as modalidades, obteve-se o índice de disparidade. Resultados: Avaliadas 15.886 ESBs, as da modalidade II apresentaram maior percentual de processo de trabalho consolidado nas regiões Sudeste (67,8 a 94,6%) e Sul (54,8 a 93,0%); observou-se maior disparidade no processo de trabalho consolidado entre ESBs da modalidade II (6,3 a 26,5), comparadas à modalidade I (3,9 a 18,4). Conclusão: ESBs da modalidade II guardam potencial para melhor desempenho no processo de trabalho, com disparidades regionais.

Objetivo: Comparar Equipos de Salud Bucal (ESB) modalidades I y II cuanto al desempeño en el proceso de trabajo y diferencias entre regiones brasileñas. Métodos: Estudio transversal con datos de la ESB adherida al Programa Nacional de Mejoramiento del Acceso y la Calidad en Atención Primaria (2013-2014). Análisis de Clases Latentes identificaron subgrupos de ESB según el desempeño (consolidado, en desarrollo o incipiente) en el proceso de trabajo (planificación de acciones, promoción de salud y atención integral). Se compararon las modalidades y se obtuvo el Índice de Disparidad. Resultados: Participaron 15.886 ESBs, las de modalidad II presentaron mayor porcentaje de proceso de trabajo consolidado en la región Sudeste (67,8% a 94,6%) y Sur (54,8% a 93,0%). La disparidad fue mayor entre la modalidad II (6,3 a 26,5) en comparación con la I (3,9 a 18,4). Conclusión: las ESBs modalidad II tienen potencial para obtener mejor desempeño en el proceso de trabajo, pero hubo disparidad regional.

Objective: To compare Modality I and Modality II Oral Health Teams (OHT) regarding work process performance and differences between Brazilian regions. Methods: This was a cross-sectional study with OHTs that took part in the National Program for Primary Health Care Access and Quality Improvement (2013-2014). Latent Class Analysis identified OHT subgroups according to work process (action planning, health promotion actions and comprehensive health care) performance (consolidated, developing or incipient). OHT modalities were compared, resulting in an Index of Disparity. Results: After evaluating 15,886 OHTs, Modality II OHTs were found to have a higher percentage of consolidated work processes in the Southeast (67.8%-94.6%) and Southern (54.8%-93.0%) regions. Disparity in the consolidated work process was greater among Modality II OHTs (6.3-26.5) compared to Modality I OHTs (3.9-18.4). Conclusion: Modality II OHTs have the potential for better performance regarding the work process, but with regional disparities.

Oral health work process: disparity between teams in Brazil, 2014 / Proceso de trabajo de salud bucal: disparidad entre equipos en Brasil, 2014 / Processo de trabalho em saúde bucal: disparidade entre as equipes no Brasil, 2014

Objective: To compare the Oral Health Teams (OHT) modalities I and II regarding performance in the work process and differences between Brazilian regions. Methods: Cross-sectional study with data from the OHT that joined to the National Program for Improving Access and Quality in Primary Care (2013/2014). Latent Class Analysis identified subgroups of OHT according to performance (consolidated, developing or incipient) in the work process (action planning, health promotion actions and integral health care). OHT modalities were compared and the Disparity Index was obtained. Results: 15,886 OHT participated. OHT modality II showed a higher percentage of consolidated work process in Southeast (67.8% to 94.6%) and South (54.8% to 93.0%) regions. Disparity in the consolidated work process was greater between OHT modality II (6.3 a 26.5) compared to I (3.9 a 18.4). Conclusion: OHT modality II has the potential to obtain better performance regarding the work process, but there was a regional disparity.

Objetivo: Comparar o desempenho das equipes de saúde bucal (ESB) das modalidades I e II no processo de trabalho e diferenças entre regiões brasileiras. Métodos: Estudo transversal, com dados das ESBs que aderiram ao Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (2013/2014). A análise de classes latentes identificou subgrupos de ESBs segundo desempenho (consolidado, em desenvolvimento ou incipiente) no processo de trabalho (planejamento das ações; promoção da saúde; atenção integral). Comparadas as modalidades, obteve-se o índice de disparidade. Resultados: Avaliadas 15.886 ESBs, as da modalidade II apresentaram maior percentual de processo de trabalho consolidado nas regiões Sudeste (67,8 a 94,6%) e Sul (54,8 a 93,0%); observou-se maior disparidade no processo de trabalho consolidado entre ESBs da modalidade II (6,3 a 26,5), comparadas à modalidade I (3,9 a 18,4). Conclusão: ESBs da modalidade II guardam potencial para melhor desempenho no processo de trabalho, com disparidades regionais.

The effect of caries increment on oral health-related quality of life among adolescents in Brazil: a 3-year longitudinal study.

This study aimed to assess the effect of caries increment on Oral Health-related Quality of Life (OHRQoL) of Brazilian adolescents and to evaluate the responsiveness of the Child Perceptions Questionnaire (CPQ11-14) in this group. A population-based sample of 515 Brazilian 12-year-olds from a large city located in the southeast of Brazil was evaluated according to a random multistage sampling design at baseline and 291 at three years follow-up, using the DMFT index and the CPQ11-14 instrument. To evaluate the responsiveness to change, the measures of effect size and longitudinal construct validity were used. It was verified that OHRQoL among adolescents with DMFT increment across the three years worsened significantly (p<0.05) in relation to their counterparts. The effect size varied from small to moderate. The longitudinal construct validity of CPQ11-14 was satisfactory. Caries increment impacted on OHRQoL of adolescents in Brazil. The CPQ11-14 instrument demonstrated acceptable responsiveness properties.

Public oral health services performance in Brazil: Influence of the work process and service structure.

The quality of oral health care might be evaluated based on Donabedian's structure-process-outcome model. This study assessed the association between the oral health public services structure and work process of oral health teams (OHT) and performance indicators (access and problem-solving capacity) in Brazil. Secondary data from a national program obtained through interviews and by observation in 2013/2014 were analyzed. The performance indicators were Coverage of First Scheduled Dental Appointment (FDA) (< or ≥ the mean) and Ratio between Completed Treatments and First Scheduled Dental Appointments (CT/FDA) (< 1 or ≥ 1). The structure was assessed by the sum of available instruments, equipment, and supplies. Latent class analyses were used to identify similar groups (consolidated, developing, and incipient) of OHT according to the work process (planning of actions, health promotion and intersectoral actions, and integral health care). Each OHT was also described regarding the number of the health team in which the OHT operates, whether the primary care unit receives students/teaches, frequency of care provided outside of OHT coverage, and participation in telehealth. Multiple logistic regression models were adjusted for each performance indicator. A total of 16189 (99,8%) and 16192 (99,9%) OHTs located in 4344 (78,0%) municipalities had complete data on the work process and structure. 91.92% of OHTs presenting CT/FDA ≥ 1 and 37.05% presenting FDA ≥ the mean. Consolidated planning of actions and better structural conditions were associated with better performance. A higher frequency of CT/FDA ≥ 1 was observed among OHTs with consolidated integral health care and those that performed telehealth. OHTs that served individuals outside of OHT coverage daily and that worked with two to nine Health Teams presented a higher frequency of FDA ≥ the mean. OHTs with better structural and work process conditions had better performance.

Prevalence of temporomandibular disorder and its association with stress and anxiety among university students / Prevalência de Disfunção Temporomandibular e sua associação com Estresse e Ansiedade entre Universitários

Objective: The objective was to evaluate the prevalence of Temporomandibular Disorders (TMD) and the association with stress and anxiety among university students. Material and Methods: The Fonseca Anamnestic Index, Trait-State Anxiety Inventory (IDATE) and LIPP Stress Symptom Inventory (LIPP) were applied for 714 voluntaries. Descriptive and inferential statistical analyzes were performed using the chi-square or Fisher's exact test and the Student's t-test or ANOVA, significance level of 5%. Results: The prevalence of TMD was 68.63%, 46.9% had mild TMD. There was a statistically significant difference between the means of age and the severity of the TMD, higher mean values for severe TMD (22.5 ± 3.3 years). There was a statistically significant association between the female and TMD, higher prevalence of mild TMD. Among the volunteers diagnosed with TMD, a significant number were diagnosed without stress, but there was a statistically significant association between those diagnosed with stress and mild TMD, anxiety and TMD, (state: moderate anxiety and DTM - 50%; trait: moderate and severe anxiety and mild DTM - 49.3% and 49.87%, respectively). Conclusion: There was a high prevalence of TMD signs and symptoms, with higher prevalence in the female gender, mild TMD was more significant, and anxiety and stress were significantly present among university students with TMD signs and symptoms. (AU)

Objetivos: A disfunção temporomandibular (DTM) consiste em uma desordem multifatorial, que envolve a articulação temporomandibular, os músculos mastigatórios e estruturas associadas. Fatores psicológicos como estresse e ansiedade estão associados com seu desenvolvimento. Alunos universitários, em virtude de apresentar a faixa etária de maior prevalência e estaremsob estresse e/ou ansiedade, despertam interesse para estudos daDTM. O objetivo foi avaliar a prevalência de DTM e a associação com estresse e ansiedade entre os universitários. Material e Métodos: foram entrevistados 714 estudantes de todos os cursos de uma universidade, de ambos os gêneros. Foram aplicados o Índice Anamnésico de Fonseca, Inventário de Ansiedade Traço-Estado (IDATE) e Inventário de Sintomas de Estresse de LIPP (LIPP). Foram realizadas análises estatísticas descritivas e inferenciais, com uso do teste Qui-quadrado ou exato de Fisher e do teste t-Student ou ANOVA, de acordo com a indicação, com nível de significância de 5%. Resultados: De acordo com os dados obtidos, a prevalência de DTM entre universitários foi de 68,63%, sendo que 46,9% apresentaram DTM leve. Houve diferença estatisticamente significativa entre as médias de idade e a severidade da DTM, de modo que se evidenciou maiores médias na DTM severa (22,5 ± 3,3 anos). Quanto ao gênero, os dados registraram associação estatisticamente significante (p < 0,05) entre o feminino e DTM, com maior prevalência da DTM leve. Com relação ao perfil psicológico dos voluntários diagnosticados com DTM, um número significativo foi diagnosticado sem estresse, porém houve associação estatisticamente significativa entre aqueles diagnosticados com estresse e DTM LEVE, ansiedade e DTM (p < 0,05), (estado: ansiedade MODERADA e DTM LEVE (50%), e traço: ansiedade MODERADA E SEVERA e DTM LEVE (49,3 % e 49,87%, respectivamente). Conclusões: concluiu-se que existe uma elevada prevalência dos sinais e sintomas de DTM entre os universitários, com maior prevalência no gênero feminino, severidade de DTM mais significante foi a leve e a ansiedade e o estresse estiveram significantemente presente entre os portadores dos sinais e sintomas de DTM. (AU)

The effect of caries increment on oral health-related quality of life among adolescents in Brazil: a 3-year longitudinal study

Abstract This study aimed to assess the effect of caries increment on Oral Health-related Quality of Life (OHRQoL) of Brazilian adolescents and to evaluate the responsiveness of the Child Perceptions Questionnaire (CPQ11-14) in this group. A population-based sample of 515 Brazilian 12-year-olds from a large city located in the southeast of Brazil was evaluated according to a random multistage sampling design at baseline and 291 at three years follow-up, using the DMFT index and the CPQ11-14 instrument. To evaluate the responsiveness to change, the measures of effect size and longitudinal construct validity were used. It was verified that OHRQoL among adolescents with DMFT increment across the three years worsened significantly (p<0.05) in relation to their counterparts. The effect size varied from small to moderate. The longitudinal construct validity of CPQ11-14 was satisfactory. Caries increment impacted on OHRQoL of adolescents in Brazil. The CPQ11-14 instrument demonstrated acceptable responsiveness properties.

The importance of the evaluation of expectations and perceptions to improve the dental service quality.

Purpose The purpose of this paper is to evaluate the use of SERVQUAL to assess service quality in Dentistry, by evaluating patients' expectations and perceptions of dental care and their association to patients' sociodemographic data. Design/methodology/approach The sample constituted of 379 subjects in the first assessment and 155 in the second phase. All employees of the companies that were clients of the dental insurance participated, a total of four companies in two states (São Paulo and Minas Gerais) of Brazil. SERVQUAL questionnaires about expectations and sociodemographic data were dispatched in the first phase, and in a second phase SERVQUAL questionnaires about perceptions. Those who had not yet received dental treatment and had agreed to participate filled out their survey in the first phase. In the second phase, the respondents had to have completed their treatment. Findings When the value gap is considered, Reliability (as a dimension) had the smallest score (-3.71). This means that it was the worst result, i.e. there is a higher difference between expectations and perceptions, and problems can be identified here. t-test confirmed that all the dimensions had some statistically significant difference with p<0.05 in relation to expectations and perceptions. Women presented higher prevalence of dissatisfaction (Tangible and Reliability dimensions), as well as the oldest participants (Empathy dimension) and those with lower parental literacy (Assurance and Empathy dimensions). The only dimension that was not significantly associated was Responsiveness. Originality/value This research suggests that the patients evaluated the physical characteristics of the premises and the interaction with the staff as the priority issues that need special attention in this service. Moreover, the use of SERVQUAL was extremely relevant for the oral health service, because it assessed the users' subjective perceptions.

Impact of a dental care program on the quality of life of children with and without caries.

The aim of the present study was to evaluate the long-term effects of the caries treatment provided by a dental care program on changes in schoolchildren's OHRQoL. A one-year follow-up was conducted with a sample of 372 children aged 8 to 10 years which were clinically examined and divided into two matched groups according to their caries experience: dental treatment group (DTG) and group without caries (GWC). Both groups were assessed three times (at baseline, at 4 weeks, and at 1 year) using the Child Perceptions Questionnaire (CPQ8-10). The normality test was performed for the statistical analyses; the Friedman test was used for the dependent variables (longitudinal assessment repeated three times for the same group); and the Mann-Whitney test was used for the independent variables (test and control groups in each time period). There was improvement in all domains and in overall CPQ8-10 (p < 0.0001) in the DTG over time, but no significant changes (p > 0.05) were observed at baseline for overall CPQ8-10 and for the emotional well-being domain in the GWC. The comparison between groups demonstrated that OHRQoL was persistently better for the GWC (p < 0.05) over time. In conclusion, dental caries treatment has a long-term positive impact on schoolchildren's OHRQoL, highlighting the importance of health policies that promote access to dental care for this population.

Impact of a dental care program on the quality of life of children with and without caries

Abstract: The aim of the present study was to evaluate the long-term effects of the caries treatment provided by a dental care program on changes in schoolchildren's OHRQoL. A one-year follow-up was conducted with a sample of 372 children aged 8 to 10 years which were clinically examined and divided into two matched groups according to their caries experience: dental treatment group (DTG) and group without caries (GWC). Both groups were assessed three times (at baseline, at 4 weeks, and at 1 year) using the Child Perceptions Questionnaire (CPQ8-10). The normality test was performed for the statistical analyses; the Friedman test was used for the dependent variables (longitudinal assessment repeated three times for the same group); and the Mann-Whitney test was used for the independent variables (test and control groups in each time period). There was improvement in all domains and in overall CPQ8-10 (p < 0.0001) in the DTG over time, but no significant changes (p > 0.05) were observed at baseline for overall CPQ8-10 and for the emotional well-being domain in the GWC. The comparison between groups demonstrated that OHRQoL was persistently better for the GWC (p < 0.05) over time. In conclusion, dental caries treatment has a long-term positive impact on schoolchildren's OHRQoL, highlighting the importance of health policies that promote access to dental care for this population.

The impact of social determinants on schoolchildren's oral health in Brazil.

The aim of this study was to evaluate the impact of socioeconomic status, home environment, and self-perception of health conditions on schoolchildren's dental caries experience. A total of 515 twelve-year-old schoolchildren from Juiz de Fora, State of Minas Gerais, Brazil, were selected into a random multistage sample. The schoolchildren were examined for the presence of caries lesions using the decayed/missing/filled teeth (DMFT) index and categorized as caries-free (DMFT = 0) or with caries experience (DMFT > 0). The participants and their parents were asked to answer a questionnaire about socioeconomic status, home environment, and self-perception of their health conditions. The hierarchical multiple regression model was used to assess the associations, since a binary response variable was assumed. The bivariate analysis revealed that variables at four levels, such as type of school, monthly family income, parents' education, home ownership, number of people living in the household, household overcrowding, parents' perception of their children's oral health, and schoolchildren's self-perception of their oral health (p < 0.05), were significantly associated with children's worse dental caries conditions. The regression model results showed that type of school and monthly family income had a strong negative effect on schoolchildren's dental caries experience (p < 0.05) in the final statistical model, where all levels were included. It was observed that socioeconomic factors were considered a strong risk indicator of schoolchildren's caries experience among the investigated social determinants of oral health.