Educational strategies in oral healthcare for the disabled and their effects on dental students' training.

PURPOSE: To evaluate the effects of didactic and clinical training of dental students in treating Persons with Disabilities (PwD) on their self-perceptions about treating PWD. METHODS: A pre-and postevaluation of a didactic-clinical educational strategy targeting oral health care of PwD was conducted among fourth-year undergraduate dental students at a Brazilian dental school. Semi-structured questionnaires were used to assess the following work environment parameters: technical, organizational, social, ethical, and managerial acumen. Data were analyzed using Fisher's exact and chi-square tests, with a significance level of 5% (p < 0.05), to verify possible associations between the quantitative variables. A qualitative analysis was conducted through collective subject discourse. RESULTS: Significant differences were found in the self-perception of students' knowledge and abilities in providing low-complexity care for PwD before and after the training program (p = 0.025). Students were more confident about managing and organizing the work environment (p = 0.007) and providing humanized care to PwD (p = 0.042) posttraining program. Additionally, a decrease in the feeling of insecurity (p = 0.014) and feelings of pity, fear, or prejudice toward PwD (p < 0.001) were observed posttraining program. CONCLUSIONS: Didactic and clinical training interventions for treating PwD improved the work environment of undergraduate dental students in technical, managerial, organizational, and ethical/social dimensions.

Educational strategies for oral assistance for the disabled and their effects on dentistry students' formation: A systematic review.

AIMS: This systematic review aimed to analyze the influence of educational strategies for oral health care for Persons with disabilities (PwDs) on the technical, ethical, and social training of undergraduate dental students. METHODS AND RESULTS: An extensive search was performed in the following databases: Cochrane, Embase, PubMed, Scopus, Web of Science, LILACS/BBO and OpenGrey database. Observational, nonrandomized, and quantitative comparisons before and after some type of educational strategy in undergraduate dentistry was included. The risk of bias was assessed using the risk of bias in nonrandomized intervention studies (ROBINS-I) tool. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Nine were included and suggested that a significant improvement was observed in the technical training of undergraduate dental students although there was no consensus on the acquisition of ethical/social competences after the application of educational strategies. The included studies presented a moderate to serious risk of bias, and the certainty of evidence for both, technical and ethical/social evaluative constructs, as very low. CONCLUSION: Although studies show that awareness regarding PwD significantly increases technical skills in dental students, the evidence is poor due to the high risk of bias and inconsistency observed in both the technical and ethical/social constructs; further studies on this topic are therefore essential. Prospero: (CRD42021288463).

Association of clinical, social and environmental variables with dental caries prevalence in adolescents from a Brazilian municipality supplied with fluoridated water / Associação de variáveis clínicas, sociais e ambientais sobre a cárie dentária em adolescentes de um município brasileiro com água fluoretada

Abstract Background Although a trend towards dental caries reduction has been observed, further investigations on its pattern and development are still needed. Objective To investigate the influence of clinical, social and environmental variables on dental caries prevalence in adolescents from a Brazilian municipality supplied with fluoridated water in 2018. Method This study was conducted with a non-probabilistic sample of 277 adolescents aged 12 years of public schools in Nova Friburgo, state of Rio de Janeiro, Brazil. Clinical examinations were carried out by calibrated examiners to assess caries, periodontal disease, and fluorosis according to criteria of the World Health Organization (WHO). Semi-structured questionnaires were applied to record socio-environmental information. Results Individuals living in regions supplied with fluoridated water below the minimum required levels (OR=3.60, p=0.0006), with low income (OR=1.90, p=0.0444), presence of gingivitis (OR=3.36; p=0.0016), and whose reason for visiting the dentist was dental treatment (OR=2.41; p=0.0203) were more likely to have dental caries. A significant reduction (p<0.0001) in dental caries indexes was observed between 2012 and 2018. Conclusion Fluoridation of public water supply at unsuitable levels, as well as other social and clinical variables can influence the caries pattern in adolescents.

Resumo Introdução A tendência de redução da cárie dentária tem sido constatada, apesar de maiores investigações sobre seu padrão e desenvolvimento serem ainda necessárias. Objetivo investigar a influência de variáveis clínicas, sociais e ambientais sobre a cárie em adolescentes de um município brasileiro com água fluoretada, no ano de 2018. Método Empregou-se uma amostra não probabilística de 277 adolescentes de 12 anos, de escolas públicas de Nova Friburgo, Rio de Janeiro, Brasil. Exames clínicos foram realizados por examinadores calibrados, para avaliação de cárie, doença periodontal e fluorose, sob critérios da Organização Mundial da Saúde (OMS). Questionários semiestruturados foram aplicados para coletar informações socioambientais. Resultados Indivíduos residentes em regiões com flúor na água em subdoses (OR=3,60, p=0,0006), e aqueles com baixa renda (OR =1,90, p=0,0444), com presença de gengivite (OR = 3,36; p = 0,0016) e cuja razão para a visita ao dentista foi para tratamento dentário (OR=2,41; 0,0203), apresentaram mais chances de terem cárie. Uma redução significativa (p<0,0001) nos índices de cárie foi observada entre 2012 (primeiro levantamento epidemiológico) e 2018. Conclusão A fluoretação das águas de abastecimento público, quando em níveis não adequados, assim como outras variáveis sociais e clínicas, podem influenciar o padrão de cárie nos adolescentes.

Clinical and Social Variables Association on the Frequency of Intellectual Disability Persons to Dental Care

ABSTRACT Objective: To evaluate the association of oral health indicators and social variables on the frequency of visit to the dentist by persons with intellectual disability (ID). Material and Methods: The study comprised a sample consisting of 149 participants with ID, aged from 11 to 29 years, from non-governmental institutions. Semi-structured interviews were held to collect sociodemographic and psychosocial information with their parents/guardians, followed by oral health evaluations in accordance with World Health Organization criteria. Crude analyses and multiple analysis were conducted to test whether oral health indicators and social data were predictors of the visit to dental care services. Results: In the multiple logistic regression model, individuals with lower DMF-t (OR=3.13; 95% CI=1.40-6.97) and those with less crowded housing (OR=2.33; 95% CI=1.06-5.12) presented less frequency of visits to oral health services. Conclusion: DMFT and crowded housing are associated to the frequency of persons with intellectual disability to dental care as well as this outcome measure affects the oral health of persons with ID. Therefore, identifying limiting factors to dental care of persons with intellectual disability is needed so that this group can receive adequate attention.

The influence of the Brazilian school health program on the oral-health-related quality of life of adolescents.

The aim of this study was to evaluate the influence of the Brazilian School Health Program (SHP) on dental clinical disorders such as caries, gingivitis, and dental trauma as well as on the oral-health-related quality of life (OHRQoL) of adolescents in Nova Friburgo, RJ, Brazil. The study consisted of a non-probabilistic (convenience) sample comprising 319 12-year-old adolescents, both participants and non-participants of the SHP, for at least two years. Socio-demographic and OHRQoL questionnaires (CPQ11-14, the Child Perceptions Questionnaire) were applied as well as clinical examinations for caries, periodontal disease, and dental trauma following the World Health Organization (WHO) criteria by calibrated researchers. Mann-Whitney, chi-square tests, and multiple logistic regression models were used for the data analysis. Statistically significant differences were observed between the groups covered and not covered by the SHP for gingivitis (p = 0.0373) and OHRQoL on the social welfare subscale (p = 0.0265) and total scale (p = 0.0449) of CPQ11-14. Multivariate analysis showed that female adolescents were 1.74 times more likely to present a lower OHRQoL (OR = 1.74, 95%IC = 1.10-2.77, p = 0.0183) than males. In addition, non-SHP subjects were 1.56 times more likely to have poor OHRQoL (OR = 1.56, 95%IC = 0.94-2.59, p = 0.0873) than program participants. In conclusion, SHP positively influenced the OHRQoL of adolescents. However, follow-up studies are needed to verify the continued effectiveness of this Brazilian SHP in improving the oral health levels and quality of life of adolescents.

Effects of oral health promotion programmes on adolescents' oral health-related quality of life: A systematic review.

OBJECTIVE: To evaluate the effects of oral health promotion programmes (OHPP) on adolescents' oral health-related quality of life (OHRQoL). METHODS: An electronic search was performed in five databases (MEDLINE via PubMed, Scopus, Virtual Health Library, Web of Science, Cochrane, Grey Literature databases), and specific indexers were used in the manual search. Clinical/community trials, cross-sectional or cohort studies, published in any language, were included. Studies meeting the inclusion criteria were analysed for quality and bias risk. RESULTS: From a total of 2343 abstracts, 4 articles were selected for quality evaluation including 2 studies classified with low, 1 with moderate and 1 with high methodological quality. The qualitative synthesis showed some methodological biases and heterogeneous interventions. Effective OHPP improve OHRQoL. The association of educational and dental care strategies generated greater positive effects on OHRQoL than those related only to treatment or isolated educational practices. CONCLUSION: Although studies showed positive effects of OHPP on adolescents' OHRQoL, both their shortage and low methodological quality indicates the need for developing other well-designed studies to investigate the present question. Record number in PROSPERO database (CRD42018084434).

The influence of the Brazilian school health program on the oral-health-related quality of life of adolescents

Abstract The aim of this study was to evaluate the influence of the Brazilian School Health Program (SHP) on dental clinical disorders such as caries, gingivitis, and dental trauma as well as on the oral-health-related quality of life (OHRQoL) of adolescents in Nova Friburgo, RJ, Brazil. The study consisted of a non-probabilistic (convenience) sample comprising 319 12-year-old adolescents, both participants and non-participants of the SHP, for at least two years. Socio-demographic and OHRQoL questionnaires (CPQ11-14, the Child Perceptions Questionnaire) were applied as well as clinical examinations for caries, periodontal disease, and dental trauma following the World Health Organization (WHO) criteria by calibrated researchers. Mann-Whitney, chi-square tests, and multiple logistic regression models were used for the data analysis. Statistically significant differences were observed between the groups covered and not covered by the SHP for gingivitis (p = 0.0373) and OHRQoL on the social welfare subscale (p = 0.0265) and total scale (p = 0.0449) of CPQ11-14. Multivariate analysis showed that female adolescents were 1.74 times more likely to present a lower OHRQoL (OR = 1.74, 95%IC = 1.10-2.77, p = 0.0183) than males. In addition, non-SHP subjects were 1.56 times more likely to have poor OHRQoL (OR = 1.56, 95%IC = 0.94-2.59, p = 0.0873) than program participants. In conclusion, SHP positively influenced the OHRQoL of adolescents. However, follow-up studies are needed to verify the continued effectiveness of this Brazilian SHP in improving the oral health levels and quality of life of adolescents.

Analysis of clinical, demographic, socioeconomic, and psychosocial determinants of quality of life of persons with intellectual disability: a cross-sectional Study.

AIMS: To evaluate the perception of parents about the impact of oral problems in their children, and of demographic, socioeconomic and psychosocial factors on the oral health-related quality of life (OHRQoL) of Brazilian adolescents and young adults with intellectual disability (ID), in 2014. METHODS: The sample consisted of 119 individuals. Data collection was performed in stages: calibration and pilot study; Application of questionnaires; Exam of caries, periodontal and need for dental prostheses, in accordance with the World Health Organization criteria. The data were subjected to both bivariate and multivariate analyses to test the association of independent variables with the dependent variable (QoL). RESULTS: Worse QoL was associated with the presence of periodontal pocket (p = 0.03; OR = 2.50; 95% CI 1.06 to 5.90), treatment need (p = 0.01; OR = 5.00; 95% CI 1.37 to 18.31), and need for dental prostheses (p = 0.03; OR = 2.89; 95% CI 1.13 to 7.37). CONCLUSION: It was concluded that clinical determinants had the greatest influence on OHRQoL of individuals with ID.

Dental Care for an adolescent with chromosome pentasomy: rare case report with a two year follow-up / Atenção Odontológica a jovem com pentassomia cromossômica: relato de caso raro com acompanhamento de 2 anos

Pentasomy of the x chromosome is a rare syndrome of unknown incidence and there are few reports in the scientific literature, especially in terms of dental care for patients with this syndrome. The aim of this study was to report the dental care given to an adolescent with pentasomy of the X chromosome. The patient presented a cleft palate, impacted teeth, malocclusion, high caries activity, gingivitis and multiple tooth loss due to caries. Despite the difficulties of carrying out the dental work due to involuntary movements and the initial lack of collaboration from the patient the overall dental care was completed on an outpatient basis. The therapeutic success of the treatment was strongly supported by the significant cooperation and relationship that grew up along the period of the treatment, as well as the desire to have the treatment done by both the patient and her parents.

A pentassomia do cromossomo x é uma síndrome rara, de incidência desconhecida e com poucos relatos na literatura científica, especialmente no que diz respeito à atenção odontológica para pacientes portadores da mesma. O objetivo deste estudo foi relatar um caso de atenção odontológica a uma jovem com pentassomia do cromossomo x, que apresentava fenda palatina, dentes inclusos, má-oclusão, alta atividade de cárie, gengivite e múltiplas perdas dentárias devido à cárie. Apesar das dificuldades de se realizar o tratamento dentário devido aos movimentos involuntários e a não colaboração inicial da paciente, houve total viabilidade da atenção odontológica em âmbito ambulatorial, observando-se significativa cooperação, formação de vínculo e adesão ao tratamento pela mesma e seus responsáveis, o que gerou sucesso terapêutico.

Determinantes Sociais e sua Relação com a Experiência de Cárie em Adolescentes: um Estudo Transversal / Social Determinants and Their Relationship with the Dental Caries in Adolescents: a Cross Sectional Study

Recursos materiais e não materiais têm sido investigados para o entendimento do processo saúde-doença. Entretanto, o papel do suporte social na proteção/desenvolvimento de doenças bucais, como a cárie dentária, ainda parece obscuro. O objetivo deste estudo foi avaliar a influência dos recursos socioeconômicos e psicossociais na experiência de cárie em adolescentes residentes em duas regiões de Nova Friburgo, Lumiar e Olaria. A amostra não probabilística compreendeu 45 adolescentes de Lumiar e 75 de Olaria de 12 anos de idade de escolas públicas deambas regiões. Os resultados foram avaliados através de análise descritiva e mostraram uma baixa prevalência de cárie (CPO-D 1,13), para os adolescentes de Lumiar, e CPO-D= 3,27 para grupo de polarização da doença. Em Olaria, observou-se um valor médio de CPO-D dosadolescentes de 1,84. O grupo de polarização da cárie nos residentes do bairro de Olaria apresentou CPO-D= 4,21. Houve tendência à maiorescolaridade estar relacionada aos responsáveis dos adolescentes livres de cáries. Concluiu-se que a escolaridade dos responsáveis parece ser um possível fator relacionado à experiência de cárie e que o capital social pode ter influenciado a experiência de cárie.

Material and non-material resources have been investigated to understand the health-disease process. However, the role of social support in the protection/development of oral diseases such as dental caries still seems unclear. This study evaluated the effect of socio-economic and psychosocial resources on caries experience in adolescents in two regions of Nova Friburgo, Lumiar and Olaria. The non-probabilistic sample comprised of 45 and 75 12 year old students of public schools, living in Lumiar and Olaria, respectively. The evaluation involved an examination of dental caries on the adolescents, according to WHO criteria, besides a semi-structured interview with each tutor of the adolescents, in home environments, in order to record information about the different material and non-material resources. The descriptive results showed a low prevalence of caries (D3 MFT 1.13) and a polarization group- SIC Index (Significant Caries Index) - with a D3 MFT mean of 3.27 for the adolescents living in Lumiar. The D3 MFT mean was 1.84 and SIC Index was 4.21 in the adolescent group in Olaria. Thus,education of the tutor seemed to lead to protection against the disease and social capital may have influenced the caries experience by behavingnegatively as a detrimental factor to oral health in adolescents.

Fluoretação da Água e seu Heterocontrole no Município de Nova Friburgo, Rio de Janeiro - Brasil / Water Fluoridation and its external control in the municipality of Nova Friburgo, Rio de Janeiro - Brazil

A fluoretação da água, apoiada pela Política Nacional de Saúde Bucal, tem sido um desafio no Brasil, devido a algumas insuficiências atuais na gestão pública para a implantação e controle desta medida. Este estudo objetivou vigiar, de forma periódica e sistemática, os níveis de fluoretos na água para consumo humano, em Nova Friburgo - RJ- Brasil (NF), por um período de 12 meses, como medida de heterocontrole, realizada por uma universidade pública. As amostras de água foram coletadas mensalmente, em duplicata, em 26 localidades em todo o município e em datas estabelecidas por sorteio. O método para medir a concentração de fluoretos nas amostras de água foi o eletrométrico, utilizando-se um potenciômetro digital com eletrodo específico para o íon flúor. A concentração de fluoretos nas amostras foi analisada de acordo com padrões fornecidos pelo Cecol/USP (2011). Os dados mostraram grande variação na concentração de fluoretos nas amostras, variando entre um mínimo de 0,00 ppmF e um máximo de 0,98 ppmF, com algumas dentro do intervalo de 0,65 e 0,94 ppmF, considerado o de melhor benefício para prevenir a cárie dentária. A concentração de fluoretos na água de abastecimento público do município foi considerada abaixo dos níveis mínimos exigidos, na maioria das amostras avaliadas, mesmo naquelas pertencentes às Estações de Tratamento de Água (ETA), cuja medida de fluoretação fora previamente implantada. Desta forma, a fluoretação da água e seu respectivo heterocontrole deveriam ser estabelecidos de forma contínua em NF, já que são medidas públicas relevantes para a promoção de saúde bucal.

Water fluoridation, supported by the Brazilian Oral Health Policy, has been a challenge as a public measure to protect Oral Health, due to some current insufficiencies in public management for the implantation of this measure in most Brazilian cities. The present study aimed to monitor, the levels of fluoride in drinking water in Nova Friburgo - RJ-Brazil (NF), on a regular and a systematic manner for a 12 months period, as an external control measurement performed by a public university. Water samples were collected, in duplicate, from 26 localities throughout the city, on a monthly basis, on randomly established dates. The fluoride concentration in the water samples was measured by using an ion-specific electrode coupled to a potentiometer, according to standards supplied by Cecol/USP (2011). Data showed a large variation of fluoride concentration in water samples, ranging from minimum 0.00 ppmF and maximum 0.98 ppmF, with few samples into the interval between 0.65 and 0.94 ppmF, which had the best benefit to prevent dental caries. Fluoride concentration in public water in this city can be considered under the minimum required levels in most of the evaluated samples, even in those from the Water Treatment System (WTS), which has water fluoridation. Thus, water fluoridation and its external control should be established on a regular basis in Nova Friburgo-RJ, Brazil because they are relevant public measures to promote oral health.

Dental caries in inland Brazilian adolescents and its relationship with social determinants

AIM: To identify the prevalence of dental caries in inland Brazilian adolescents, and to analyze the influence of socio-demographic and clinical variables, and access to dental service on caries experience. METHODS: This study had a non-probabilistic sample comprising 504 adolescents aged 12 years, attending public schools in the city of Nova Friburgo, mountain region of Rio de Janeiro, Brazil. The World Health Organization (WHO, 1997) criterion was used by previously calibrated examiners to report dental caries. Variables were obtained by means of a semi-structured questionnaire applied to the adolescents' parents. RESULTS: The D3MFT mean was 1.90 and the Significant Caries (SIC) Index was 4.54, mainly represented by the carious component. Multiple logistic regression analysis revealed that parents with over 8 years of schooling (OR=0.579), absence of pain (OR=0.396) and not visiting the dentist (OR=0.270) might suggest protective factors against the disease; the possible risk factors were male gender (OR=1.982) and pain, extraction and others were reasons for consultation (OR=2.435). CONCLUSIONS: Although the prevalence of caries was slightly below the national mean, polarization of the disease was clearly observed. Education and no access to the dentist led to protection against the disease. These results may contribute to planning of oral health actions directed towards this target population for the control of caries...

Prevalência de lesões orais na infecção por HIV em adultos e crianças / Prevalence of HIV related oral lesions in adults and children

Manifestações clínicas orais da Aids são comuns e podem ser o primeiro sinal da infecção por HIV. Elas constituem importante fator prognóstico, pois eu aparecimento indica evolução da doença. Após a introdução da terapia anti-retroviral combinada, foi observada uma redução da frequência dessas manifestações. Este estudo objetivou avaliar a prevalência de lesões orais associadas ao HIV/Aids em adultos e crianças atendidos em um serviço de referência (HUAP/UFF). Nossos dados mostram que, apesar da redução na prevalência, essas lesões ainda são frequentes, evidenciando a necessidade de um exame intra-oral regular e criterioso para melhor acompanhar a infecção pelo HIV nesses pacientes

Perfil biopsicossocial de pacientes do programa de atenção à saúde bucal do Hospital Antonio Pedro /UFF / Biopsy social profile of the patients of the program of awareness of the oral health of HIV/AIDS sufferers of the Hospital Universitário Antonio Pedro HUAP/UFF

Diante da imporância da atenção à saúde bucal de portadores do HIV e da possibilidade de ações transformadoras a partir do planejamento do programas que considerem o contexto biopsicossocial dos pacientes do Program de Anteção à Saúde Bucal de Portadores de HIV/AIDS na Coordenação do Programa de AIDS do Hospital Universitário Antonio Pedro HUAP/UFF, Optou-se por uma abordagem teórico-metodológica qualitativa, através de análise do material do diário de campo, dados das condições de sáude bucal (CPO-d, ceo-d,Biofilme visível, saúde periodontal IPC) e de indicadores sociais (renda, escolaridade, idade) de 155 pacientes e entrevistas com quatro participantes. Os principais resultados mostraram que 72 porcento tem escolaridade equivalente ao ensino fundamental; 87 porcento renda até 2 salários mínimos; CPO-d médio de 23 e 60 porcento com higiene precária, valorizam a escuta e acolhida do profissional. Conclui-se que o perfil da biopsicossocial destes pacientes é marcado por indicadores sociais e de saúde bucal desfavráveis. Os pacientes reconhecem a importância para a saúde geral, para as relações sociais e para a qualidade de vida, e para os entrevistados, o Programa de Atenção à Saúde Bucal de Pacientes soropositivos para o HIV do HUAP está tendo resultado muito satisfatórios, valorizando a qualidade do serviço e o diferencial da abordagem integral ao paciente

A saúde bucal do dependente de drogas psicotrópicas / Oral health of drug addicts

Esta pesquisa teve por objetivo analisar e comparar os fatores físicos, psicológicos e sociais que podem levar a alterações na saúde bucal de dependentes químicos. A metodologia utilizada foi qualitativa, preocupando-se com a interpretação cientíica de dados psicossociais. O universo foi de nove pacientes da Clínica Aldeia Alcool, Drogas e Compulsões, Niterói/RJ (grupo I) e, dez pacientes do CREDEQ - Centro de Reabilitação de Dependência Química, Rio de Janeiro/RJ (grupo II). Foram realizadas discussões em grupo e entrevistas relativas à saúde bucal, ao uso de drogas e indicadores sociais; além de exames clínicos. A análise utilizou aspectos individuais e coletivos dos sujeitos, comparando os grupos I e II. Foi observado que o grupo I apresentou médias de escolaridade e renda familiar maiores que as do grupo II. O exame clínico mostrou que as alterações mais frequente foram bruxismo e a xerostomia. A saúde bucal esteve associada às relações, problemas de estômago, halitose e estética. Xerostomia, bruxismo, hipoestesia e dor foram as principais mudanças notadas pelos entrevistados durante sua dependência. O descaso com a saúde bucal foi relatado por quase todos os entrevistados. A estética e os danos na cavidade bucal causam insatisfação em ambos os grupos, contudo este índice foi maior no II. Concluiu-se que a saúde bucal esteve principalmente associada à estética, vista pelo dependente como fundamental à sua reintegração na sociedade. A precariedade da saúde bucal, em ambos os grupos, pode estar relacionada ao descaso com a higiene corporal provocado pelo uso abusivo de drogas