Brazilian Pediatric Dentistry Behavior Control Model: Report of the Pioneers of the Specialty

Abstract Objective: To analyze the basis on which the behavioral approach model adopted by Brazilian Pediatric Dentistry throughout its history was built. Material and Methods: A semi-structured interview, applied to six pioneering professors in Brazilian Pediatric Dentistry, dealted with the model that followed the line of behavioral control and how this could be explained historically; on the differences between the Brazilian model and that of other schools, as well as a methodological analysis on the publications related to these models. Data were recorded and transcribed and then submitted to Bardin's qualitative content analysis Results: Three categories emerged from the analysis: "Formulation of a Brazilian theoretical model"; "Behavioral approach in Brazil and in other countries"; and "Analysis of publications under different behavioral approach models". The reports point to the construction of a model based on the sharing of professional experiences, the knowledge acquired through the literature and the compilation of techniques from different fields of knowledge/activity through idiosyncrasies, one's own abilities, such as the ease to deal with children, and personal experiences - leading to a non-scientific result. Methodological limitations in studies in this field have been reported. Qualitative research on the subject is scarce and allows further knowledge of the pediatric dental practice at its interface with Psychology for a successful treatment of pediatric patients Conclusion: The reports point to the possibilities and limitations of the formulation process of the behavioral approach model adopted by Brazilian pediatric dentistry throughout its history. The analyzed categories allowed a broad and deep overview of the historic and academic process of this important construction.

Cumprimento de metas dos Centros de Especialidades Odontológicas da Região Sul do Brasil / Achieving goals set in specialized dental centers of Southern Brazil / El cumplimento de las metas de tratamientos en las clínicas dentales especializadas en la Región Sur de Brasil

RESUMO Objetivo O objetivo do estudo foi verificar o cumprimento das metas ambulatoriais dos Centros de Especialidades Odontológicas (CEOs) localizados na Região Sul do Brasil e fatores associados aos processos de trabalho. Método O estudo foi do tipo exploratório transversal. Para a coleta de dados foram consultadas as bases de dados do DATA/SUS, CNES, SIOPS, IBGE e foi enviado um questionário semiestruturado aos gestores dos CEOs. Para verificar a associação de fatores com o cumprimento das metas dos CEOs foi utilizado o Teste de Kruskal Wallis. Resultados Foram analisados 936 meses de produção ambulatorial distribuídos em 78 CEOs, a taxa de respostas dos questionários foi de 68 % e verificou-se baixo cumprimento de metas e que as variáveis: estado do Paraná, os municípios com porte populacional de 0-50 mil/hab e o quarto quintil dos gastos totais em saúde e PIB per capita foram associados ao cumprimento de metas dos procedimentos de periodontia e o tipo de CEO apresentou associação com metas cumpridas de procedimentos básicos. Discussão As análises das variáveis que podem estar associadas à produção ambulatorial dos CEOs são fundamentais para verificar questões de acesso da população e aplicabilidade dos recursos públicos na área da saúde. Conclusões O estudo sinaliza para o baixo cumprimento de metas dos CEOs, entretanto aponta que podem haver fatores importantes associados a maior número de meses de metas cumpridas.(AU)

ABSTRACT Objective To evaluate the association of work factors with goals set in specialized dental centers (SDCs) of Southern Brazil. Methodology Cross-sectional exploratory study, in which the databases DATASUS, IBGE, SIOPS were used and complemented with an online questionnaire (FORMSUS). The questionnaire was answered by SDC managers. The Kruskal Wallis test was utilized to determine association of factors. Results Nine hundred and thirty six months, corresponding to 78 SDCs, were analyzed; the response rate of the questionnaires was 68%. It was found that the variables Paraná State, municipalities with population size of 0-50 thousand/inhabitants, and the fourth quartile of total health expenditure and Gross National Product per capita were factors associated with goals achievement of periodontal procedures. The type of SDCs showed association with goals achievement of basics procedures. Discussion Analyzes of the variables that may be associated with outpatient treatment in of SDCs are fundamental to verify issues regarding population access and applicability of public resources in the health area. Conclusion The study indicates low achievement goals by outpatient care delivery by specialized dental centers, which may indicate important factors associated with higher number months for achieving goals.(AU)

RESUMEN Objetivo El objetivo del estudio fue verificar: el cumplimento de las metas de tratamientos en las clínicas dentales especializadas (CDEs) en la Región Sur de Brasil y, los factores asociados a los procesos de trabajo. Método El estudio fue exploratorio transversal. Para la recolección de datos fueron consultadas las bases del datos provenientes de DATA/SUS, CNES, SIOSP, IBGE y fue enviado un cuestionario semiestructurado para los gestores de las CDEs. Para comprobar la asociación de los factores con el cumplimento de las metas de las CDEs se realizó el test de Kruskal Wallis. Resultados Fueron analizados 936 meses de tratamiento ambulatorio distribuidos en las 78 CDEs y la tasa de respuestas de los cuestionarios fue de 68%. Las variables: estado de Paraná, municipios con número de ciudadanos de 0-50 mil/hab, el cuarto quintil de los gastos totales en salud y PIB per cápita fueron asociados con el cumplimento de las metas de los procedimientos de periodoncia y, el tipo II de CDE presentó asociación con el cumplimento de las metas de los procedimientos básicos. Discusión El análisis de las variables que pueden estar asociadas al tratamiento ambulatorio en las CDEs es fundamental para comprobar tanto los problemas de acceso de los habitantes como la aplicabilidad de los recursos públicos en el área de la salud. Conclusiones El estudio indica un bajo cumplimento de las metas de tratamiento de las CDEs, entretanto apunta que pueden haber factores importantes asociados al mayor número de meses en las metas cumplidas.(AU)

Effect of Grape Derived Beverages in Colour Stability of Composite Resin Submitted to Different Finishing and Polishing Methods

Objective: To evaluate the influence of three methods of finishing and polishing on color stability of a microhybrid composite immersed in different beverages for 7, 15 and 30 days. Material and Methods: 90 samples were prepared and divided into three groups according to surface treatments (polyester matrix, aluminum oxide disc, sandpaper). The samples were divided for each group (n = 6) and immersed in one of the beverages: distilled water, red and white wine, red and white artificial grape juice. Pictures were taken at four time points: 0, 7, 15 and 30 days after contact with the dye. Color measurement was performed by computerized image analysis. La*b* values were obtained and color change (ΔE) was calculated. Results: Comparing beverages, red wine (ΔE =22.11±4.26) and red artificial grape juice (ΔE=8.24±1.70) showed greater color change in polyester matrix group, and finishing with aluminum oxide disc (ΔE=10.73±2.10) significantly prevent color change in red wine group. Conclusion: Aluminum oxide discs are the best option to minimize color changes in resin. White drinks are alternatives to color stability of composite resin. In the study time, composite resin demonstrated progressive discoloration when immersed in red wine and red juice. On the other hand, samples submitted to white beverages showed higher color stability.

[Achieving goals set in specialized dental centers of Southern Brazil]. / Cumprimento de metas dos Centros de Especialidades Odontológicas da Região Sul do Brasil.

OBJECTIVE: To evaluate the association of work factors with goals set in specialized dental centers (SDCs) of Southern Brazil. METHODOLOGY: Cross-sectional exploratory study, in which the databases DATASUS, IBGE, SIOPS were used and complemented with an online questionnaire (FORMSUS). The questionnaire was answered by SDC managers. The Kruskal Wallis test was utilized to determine association of factors. RESULTS: Nine hundred and thirty six months, corresponding to 78 SDCs, were analyzed; the response rate of the questionnaires was 68%. It was found that the variables Paraná State, municipalities with population size of 0-50 thousand/inhabitants, and the fourth quartile of total health expenditure and Gross National Product per capita were factors associated with goals achievement of periodontal procedures. The type of SDCs showed association with goals achievement of basics procedures. DISCUSSION: Analyzes of the variables that may be associated with outpatient treatment in of SDCs are fundamental to verify issues regarding population access and applicability of public resources in the health area. CONCLUSION: The study indicates low achievement goals by outpatient care delivery by specialized dental centers, which may indicate important factors associated with higher number months for achieving goals.

Psicologia e odontopediatria: contextualização da interdisciplinaridade no Brasil / Psychology and pediatric dentistry: interdisciplinarity contextualization in Brazil

A adaptação do comportamento da criança é um tema amplo e muito estudado em Odontopediatria. Esta revisão integrativa da literatura avaliou artigos nacionais publicados de 1980 a 2016, relacionados ao manejo comportamental em Odontopediatria. Foram analisados 87 artigos em bases de dados nacionais como a BVS, PePSIC, SciELO e LILACS. Os resultados demonstraram um número elevado de publicações relacionadas ao manejo comportamental com abordagem não farmacológica (82,75%) e o delineamento observacional transversal foi o mais prevalente, bem como um aumento de publicações, a cada década. Concluiu-se que os artigos que retratam as técnicas de abordagem não farmacológica predominam na literatura nacional, destacando-se o papel da interdisciplinaridade entre a Odontopediatria e a Psicologia, no Brasil. A produção científica ao longo do período avaliado por este estudo vincula fortemente os saberes entre as duas profissões, no intuito de promover a abordagem mais apropriada às demandas clínicas de um paciente infantil.(AU)

Handling is a broad subject and much studied in pediatric dentistry. This integrative literature review evaluated national articles published from 1980 to 2016, related to Behavioral Management in Pediatric Dentistry. Eighty seven articles were analised from national databases such as the BVS, PePSIC, SciELO and LILACS. The results showed a high number of publications related to behavioral management with a non-pharmacological approach (82,75%) and the cross-sectional observational design was the most prevalent, as well as an increase in publications, every decade. It was concluded that the articles that portray the techniques of non-pharmacological approach predominate in the national literature, highlighting the role of interdisciplinarity between Pediatric Dentistry and Psychology, in Brazil. The scientific production during the evaluated period showed a strong relation between the two professions, in order to promote the most appropriate approach to the child patient clinical demands.(AU)

Oxygen Saturation in Dental Pulp of Permanent Teeth: Difference between Children/Adolescents and Adults.

INTRODUCTION: The objective of this study was to use pulse oximetry to measure oxygen saturation in permanent maxillary central incisors with normal pulp in 2 different age groups: children/adolescents and adults. METHODS: Blood oxygen saturation levels were measured using a pulse oximeter in 110 maxillary central incisors of 57 individuals, in 1 of 2 possible age bands, as follows: 28 children/adolescents (7-13 years old) and 29 adults (22-36 years old). The following factors were also analyzed: (1) heart rate (beats/min); (2) oxygen saturation rate measured at the patient's index finger, also using a pulse oximeter; (3) tooth crown dimensions; and (4) the time taken by the oximeter to provide a reading. RESULTS: The mean oxygen saturation level in normal central incisors was higher among children/adolescents (84.35%) than adults (77.88%, P = .003). Oxygen saturation rates measured at the patients' fingers were not correlated with saturation obtained at the teeth (r = 0.10). There was no correlation between oxygen saturation readings and tooth dimensions (buccal surface area), heart rate, or oximeter reading time (P > .05). CONCLUSIONS: Oxygen saturation values measured in maxillary central incisors using a pulse oximeter revealed differences between children/adolescents and adults, showing that children/adolescents have higher oxygen saturation levels. There was no correlation between oxygen saturation levels in patients' fingers and values from their teeth or between oxygen saturation readings from central incisors and tooth dimensions (buccal surface), heart rate, or oximeter reading time.

Bibliometric analysis of scientific articles published in Brazilian and international orthodontic journals over a 10-year period.

OBJECTIVE: This study aimed at describing the profiles of Brazilian and international studies published in orthodontic journals. METHODS: The sample comprised 635 articles selected from two scientific journals, i.e., Dental Press Journal of Orthodontics and American Journal of Orthodontics and Dentofacial Orthopedics, which were analyzed at three different intervals over a 10-year period (1999 - 2004 - 2009). Articles were described in terms of knowledge domain, study design, and country of origin (or state of origin for Brazilian papers). RESULTS: The most frequent study designs adopted in international studies were cohort (23.9%) and cross-sectional (21.7%) designs. Among Brazilian papers, cross-sectional studies (28.9%) and literature reviews (24.6%) showed greater frequency. The topics most often investigated in international articles were dental materials (17%) and treatment devices (12.4%), with the latter topic being addressed by 16% of the Brazilian publications, followed by malocclusion, with 12.6%. In all cases, the most frequent countries of origin coincided with the countries of origin of each journal. CONCLUSIONS: The majority of the studies analyzed featured a low level of scientific evidence. Moreover, the findings showed that journals tend to publish studies produced in their own country of origin, and that there are marked discrepancies in the number of papers published by different Brazilian states.

[Analysis of outpatient care in Brazilian municipalities with and without specialized dental clinics, 2010]. / Análise da produção ambulatorial em municípios com e sem centros de especialidades odontológicas no Brasil em 2010.

The aim of this study was to describe the production of specialized outpatient dental services and associated factors in Brazilian municipalities (counties) with and without Specialized Dental Clinics (SDC). Data were collected from the following sources: Information Technology Department of the Unified National Health System, Human Development Atlas for Brazil, and Brazilian Institute of Geography and Statistics. Zero-inflated negative binomial regression was used to fit rates of endodontic procedures, primary care, periodontics, and surgery. After controlling for socio-demographic factors, municipalities with SDC showed higher rates for the above-mentioned procedures than those without, except for primary care. In the final model, including service structure variables, municipalities with type III SDC showed a rate of endodontic procedures that was 2.08 times higher (95%CI: 1.26; 3.44) than those without. Among the structural variables, municipalities with higher health expenditures and more dentists in the Unified National Health System showed consistently higher rates for all types of procedures. The SDC appear to have a positive effect on the local production of specialized procedures (especially endodontic), an effect not explained by structural variables.

Bibliometric analysis of scientific articles published in Brazilian and international orthodontic journals over a 10-year period

Objective: This study aimed at describing the profiles of Brazilian and international studies published in orthodontic journals. Methods: The sample comprised 635 articles selected from two scientific journals, i.e., Dental Press Journal of Orthodontics and American Journal of Orthodontics and Dentofacial Orthopedics, which were analyzed at three different intervals over a 10-year period (1999 - 2004 - 2009). Articles were described in terms of knowledge domain, study design, and country of origin (or state of origin for Brazilian papers). Results: The most frequent study designs adopted in international studies were cohort (23.9%) and cross-sectional (21.7%) designs. Among Brazilian papers, cross-sectional studies (28.9%) and literature reviews (24.6%) showed greater frequency. The topics most often investigated were dental materials (17%) and treatment devices (12.4%) in international articles, with the latter topic being addressed by 16% of the Brazilian publications, followed by malocclusion, with 12.6%. In all cases, the most frequent countries of origin coincided with the countries of origin of each journal. Conclusions: The majority of the studies analyzed featured a low level of scientific evidence. Moreover, the findings showed that journals tend to publish studies produced in their own country of origin, and that there are marked discrepancies in the number of papers published by different Brazilian states. .

Objetivo: determinar o perfil das publicações nacionais e internacionais nos periódicos de Ortodontia. Métodos: foram avaliados 635 artigos da Revista Dental Press de Ortodontia e Ortopedia Facial e American Journal of Orthodontics and Dentofacial Orthopedics, em três tempos distintos, dentro de um intervalo de 10 anos (1999, 2004 e 2009), caracterizando as áreas de conhecimento, os delineamentos utilizados e identificando países e estados brasileiros com maior produção científica. Resultados: os delineamentos dos estudos internacionais mais utilizados foram estudos de coorte (23,9%) e transversal (21,7%). Em estudos nacionais, destacam-se os delineamentos transversais (28,9%) e revisão de literatura (24,6%). Nas publicações internacionais, as categorias temáticas mais pesquisadas foram materiais dentários (17%), além de dispositivos de tratamento (12,4%); essa mesma categoria esteve presente em 16% das publicações nacionais, e a má oclusão dentária em 12,6%. A nacionalidade das publicações mais observada foi a do próprio país de origem do periódico. Conclusões : a maioria dos artigos publicados refere-se a estudos de menor potencial para estabelecer evidências científicas. Além disso, a situação detectada ilustra a propensão das revistas publicarem os artigos produzidos dentro de seu país de origem, bem como as disparidades entre os estados do Brasil quanto ao número de publicações. .

Análise da produção ambulatorial em municípios com e sem centros de especialidades odontológicas no Brasil em 2010 / Analysis of outpatient care in Brazilian municipalities with and without specialized dental clinics, 2010 / Análisis de la producción ambulatoria en municipios con y sin centros de especialidades dentales en Brasil, 2010

O objetivo foi descrever a produção de serviços especializados em municípios brasileiros com e sem Centros de Especialidades Odontológicas (CEO) e estudar fatores associados. Para a coleta de dados, foram consultados: o Departamento de Informática do SUS, dados do Atlas de Desenvolvimento Humano do Brasil e do Instituto Brasileiro de Geografia e Estatística. Utilizou-se regressão binominal negativa inflada de zeros para modelar taxas de procedimentos de endodontia, atenção básica, periodontia e cirurgia. Após controle por fatores sociodemográficos, os municípios com CEO apresentaram taxas maiores do que os sem, exceto para taxas de atenção básica. No modelo final, com variáveis de estrutura dos serviços, os municípios com CEO do tipo III tiveram uma taxa de procedimentos de endodontia 2,08 (IC95%: 1,26; 3,44) vezes maior que sem CEO. Das variáveis de estrutura, mais gastos em saúde e maiores taxas de dentistas no SUS estavam consistentemente associados a maiores taxas de quaisquer procedimentos. Os CEO parecem ter um efeito positivo na produção municipal de procedimentos especializados, particularmente para a taxa de procedimentos de endodontia, e esse efeito não é explicado por variáveis de estrutura.

The aim of this study was to describe the production of specialized outpatient dental services and associated factors in Brazilian municipalities (counties) with and without Specialized Dental Clinics (SDC). Data were collected from the following sources: Information Technology Department of the Unified National Health System, Human Development Atlas for Brazil, and Brazilian Institute of Geography and Statistics. Zero-inflated negative binomial regression was used to fit rates of endodontic procedures, primary care, periodontics, and surgery. After controlling for socio-demographic factors, municipalities with SDC showed higher rates for the above-mentioned procedures than those without, except for primary care. In the final model, including service structure variables, municipalities with type III SDC showed a rate of endodontic procedures that was 2.08 times higher (95%CI: 1.26; 3.44) than those without. Among the structural variables, municipalities with higher health expenditures and more dentists in the Unified National Health System showed consistently higher rates for all types of procedures. The SDC appear to have a positive effect on the local production of specialized procedures (especially endodontic), an effect not explained by structural variables.

El objetivo fue describir la producción de los servicios especializados en los municipios brasileños con y sin Centros Especializados Dentales (CEDs) y estudiar los factores asociados. Los datos fueron recogidos a partir de los siguientes sistemas: Departamento de Informática del SUS, Atlas del Desarrollo Humano y el Instituto Brasileño de Geografía y Estadística. Fueron utilizadas regresiones binomiales negativas infladas con ceros para ajustar las tasas de los procedimientos de endodoncia, atención primaria, periodoncia y cirugía. Después de controlar los factores sociodemográficos, los municipios con CEDs presentan tasas más altas que los sin CEDs, excepto para la tasa de atención primaria. En el modelo final, incluyendo los factores de la estructura de servicio, municipios con CEDs tipo III mostraron una tasa de procedimientos de endodoncia 2,08 (IC95%: 1,26; 3,44) veces mayor. Entre estos factores, los municipios con mayor gasto en salud y mayores tasas de dentistas en el sistema público se asociaron con tasas más altas de todos los procedimientos. Se concluye que los centros parecen tener un efecto positivo en la producción ambulatoria, principalmente para endodoncia y este efecto no se explica por las variables de estructura.

Avaliação das Condições de Saúde Bucal de Escolares Deficientes Auditivos no Município de Porto Alegre, RS, Brasil / Evaluation of the oral health conditions of deaf schoolchildren in the city of Porto Alegre, RS, Brazil

Objetivo: Avaliar a saude bucal de criancas ouvintes e surdas e verificar a associacao das condicoes observadas a fatores socio comportamentais. Metodo: Foram avaliadas 245 criancas pertencentes a duas escolas, sendo 50 deficientes auditivos. A coleta de dados foi realizada por meio de exame clinico visual para a realizacao do CPOD/ceod. Todos os dados foram anotados em uma ficha clinica padronizada. A escola enviou aos responsaveis um questionario solicitando dados socio-economicos e informacoes a respeito de habitos de saude bucal. Dois examinadores treinados e calibrados efetuaram a coleta dos dados clinicos nas dependencias das escolas e sob controle de biosseguranca. As informacoes foram inseridas em um banco de dados e estes analisados no SPSS. Foi utilizado o teste Qui-quadrado para tendencia linear (nivel de significancia p<0,05), Mann Withney e Kruskal-Wallis. Resultados: A prevalencia de carie entre individuos surdos foi de 46% e entre nao-surdos 31%, diferindo com significancia estatistica. Nao houve diferenca quanto ao genero e idade, sendo que 81% ja haviam visitado um cirurgiao-dentista. Escolaridade materna (p<0,004) e quem realizava a pratica de higiene bucal (p<0,002) estiveram associadas ao desfecho. Conclusao: Os individuos surdos apresentaram uma maior prevalencia de carie e fatores como escolaridade materna e quem realiza a pratica de higiene bucal na crianca estiveram associados ao agravo.

Objective: To evaluate, by means of a cross-sectional study, the oral health of hearing and deaf children in Porto Alegre, RS, Brazil. Method: The sample was composed of 245 children (195 hearers and 50 deaf). Data collection comprehended physical and clinical examinations (dmf-t and DMF-T) and a questionnaire filled out by the caregivers. Clinical data were collected by two trained and calibrated undergraduated students. A schools room was used for the examinations and biosafety were attended. Data were analyzed using the SPSS soft ware. The chi-square to assess the linear tendency (p<0.05), Mann Withney and Kruskal-Wallis tests were used. Results: Caries prevalence among the deaf and non-deaf individuals was 46% and 31%, respectively. There was no statistically significant difference with respect to gender and age, and 81% of the children had already been to the dentist. The variables maternal educational level (p=0.004) and who performs the child's oral hygiene (p=0.002) were associated with the prevalence observed. Conclusion: The deaf individuals showed a higher caries prevalence; factors associated with maternal educational level and who performs the child's oral hygiene were associated with this increased prevalence.

Heterocontrole da fluoretação das águas de abastecimento público do Município de Canoas/RS / External control of fluoridation in public water supply of Canoas/RS

O objetivo do estudo foi avaliar a concentração de flúor presente na água de abastecimento público do município de Canoas/RS. Amostras da água de abastecimento foram coletadas em duplicatas por 8 meses em 22 diferentes pontos agrupados em três Estações de Tratamento (ETAs) da cidade. A medição da concentração de fluoreto foi realizada através do método eletrométrico. A análise das amostras coletadas no período avaliado demonstrou haver oscilação na concentração de flúor de acordo com os meses de coleta (de 0,185 a 1,605 ppm/L). Das amostras avaliadas, 96 (54,5%) estiveram inadequadas (< 0,6 ppm; > 0,9 ppm ) quanto à concentração de flúor presente. Das amostras inadequadas, a maioria apresentou concentração superior ao limite máximo de concentração aceitável para o padrão de potabilidade. Houve diferença estatisticamente significante entre as 3 ETAs em relação à adequação da concentração de flúor (p < 0,001). A grande variação em relação à concentração de flúor presente em diferentes pontos de coleta, bem como a alta porcentagem de amostras com padrão inadequado de fluoretação revelam a necessidade de se implantar medidas de heterocontrole permanente para garantir efetividade da fluoretação das águas.

The aim of this study was to evaluate the concentration of fluoride in public water supplies in Canoas/RS. Samples of drinking water were collected in duplicates for eight months on22 different points grouped into three water treatment plants of the city. The measurement of fluoride concentration was performed using the electrometric method. The analysis of samplescollected in the study period showed that there was oscillation in fluoride concentrations in accordance with the sampling months (from 0.185 to 1.605 ppm /L). Of the samples, 96 (54.5%)were inadequate (<0.6 ppm> 0.9 ppm) as the fluoride concentration. Of inadequate samples, the majority showed concentrations above the maximum acceptable concentration for drinking water standard. There was statistically significant difference among the three water treatment plantsregarding the suitability of the fluoride concentration (p <0.001). The large variation in relation to fluoride concentration as well as the high percentage of inadequate samples revealed the need to implement measures of external control to ensure continuous effectiveness of water fluoridation.

Processo de trabalho do sistema de referência e contra-referência da área da Odontologia / Work process of the reference and counterreference dentistry systems

O objetivo do presente estudo foi analisar o processo de trabalho do sistema de referência e contrareferência da área da Odontologia. Para subsidiar a análise normativa e comparativa foram realizadas entrevistas compostas de oito perguntas fechadas dirigidas aos Secretários Municipais de Saúde (SMS) e Coordenadores das Unidades Básicas de Saúde (UBS) de uma Coordenadoria Regional da Saúde (CRS) do RS composta por doze municípios. Após a realização das entrevistas os dados foram tabulados em freqüências simples. Para análise comparativa as respostas obtidas nas SMS(s) foram consideradas como padrão ouro para emitir juízo de valor. No final da análise foram identificadas potencialidades e limitações do processo de trabalho da interface de governabilidade municipal. Conclui-se que o processo de trabalho do sistema de referência e contra-referência da área da odontologia deve ser planejado pelos gestores das SMS(s) e UBS(s) com a coordenação da CRS para adequar as necessidades de cada município (AU).

The aim of this study was to analyze the work process of the reference and counter-reference dentistry systems. Interviews were conducted to aid in making a comparative and normative analysis. Eight closed questions were asked, directed at the Municipal Secretaries of Health (SMS) and coordinators of Basic Health Units (UBS) from the same Regional Health Coordinator's Office (CRS), handling 12 municipalities of the state of Rio Grande do Sul. After conducting the interviews, the data were tabulated according to simple frequency. For the purpose of comparative analysis, the SMS(s) were considered as the gold standard for issuing value judgments. Once concluded, the analysis identified potentials and limitations of the municipal governability interface work process. We concluded that the work process of reference and counter-reference of the dentistry system should be planned by managers from the SMS(s) and UBS(s) coordinated by the Regional Health Coordinator's Office (CRS) in order to meet the specific needs of each municipality (AU).

Evaluation of final-year dental students concerning therapeutic decision making for proximal caries.

This cross-sectional study aimed to determine the radiographic criteria used by final-year dental students when defining the need for restorative treatment for proximal caries, as well as investigating potentially associated factors in this therapeutic decision. A questionnaire with two schematic diagrams presenting five levels of proximal lesion penetration was administered to students attending the six private and three public dental schools in the state of Rio Grande do Sul, Southern Brazil. Absolute and relative frequencies were described and inferential statistics involving Chi-square and McNemar tests and simple logistic regression were carried out to assess variations in therapeutic decisions related to patient dentition (deciduous/permanent) and gender, age and dental school (public/private). Of the 346 dental students assessed, 28.6% (99/346) indicated restorative treatment for lesions restricted to the enamel in deciduous teeth and 38.2% (132/346) indicated the same for permanent teeth, revealing a statistically significant difference (p = 0.001). Student gender and age were not associated with the therapeutic decision; however, a significant difference between dental schools was found when comparing restorative criteria in deciduous (p < 0.001) and permanent molars (p < 0.001). The odds of restorative decision in permanent teeth when the caries lesion was restricted to the enamel was 72% higher for students graduating from private schools compared to public schools (Odds Ratio: 1.72; 95% Confidence Interval: 1.03-2.90). These data demonstrate a large variation between the therapeutic decisions regarding proximal caries reported by final-year dental students and suggest that deep reflection is needed on the part of faculty in order to provide an evidence-based education.

Capital Social e Sistema Único de Saúde (SUS) no Brasil / Social Capital and the National Health System (SUS) in Brazil

O objetivo principal deste artigo é construir um referencial teórico preliminar que possibilite a compreensão das razões que podem determinar o desempenho satisfatório das instituições de saúde no Brasil, particularmente o do Sistema Único de Saúde (SUS). A hipótese teórica, a partir dos estudos de Putnam (2005), é de que o acúmulo de Capital Social (CS) em determinada sociedade está positivamente relacionado à capacidade de os governos atenderem e realizarem as demandas da população. Em outras palavras, os níveis de solidariedade e de confiança interpessoais e a existência de organizações sociais são elementos colaborativos para o desempenho das instituições políticas. O CS, na área da saúde, funcionaria como elemento de impacto positivo, não somente pelo fato de proporcionar uma vida mais saudável para as populações, reduzindo a exclusão social e aumentando a longevidade e a autoestima, mas também por ter um papel fundamental no estímulo da participação da comunidade tanto na formulação de políticas públicas como no seu controle social, o que possibilitaria o melhor funcionamento das instituições. Nesse sentido, utilizamos os dados de pesquisa quantitativa aplicados em usuários do SUS em duas cidades do Rio Grande do Sul (Caxias e Pelotas).

The main objective of this paper is to construct a preliminary theoretical framework that enables the understanding of the reasons that may determine the satisfactory performance of health institutions in Brazil, particularly that of the National Health System (SUS). Based on the study of Putnam (2005), the theoretical hypothesis is that the accumulation of Social Capital (SC) in a certain society is positively related to the governments' ability to meet the population's demands. In other words, the levels of interpersonal solidarity and trust and the existence of social organizations collaborate with the performance of the political organizations. In the health area, SC would work as an element of positive impact, not only because it offers a healthier life to populations, reducing social exclusion and increasing longevity and self-esteem, but also because it plays a fundamental role in the stimulation to community's participation, both in the formulation of public policies and in their social control, which would enable the better functioning of the institutions. In this sense, we used data from a quantitative research study applied to SUS users in two cities of the state of Rio Grande do Sul (Caxias and Pelotas).

Evaluation of final-year dental students concerning therapeutic decision making for proximal caries

This cross-sectional study aimed to determine the radiographic criteria used by fi nal-year dental students when defi ning the need for restorative treatment for proximal caries, as well as investigating potentially associated factors in this therapeutic decision. A questionnaire with two schematic diagrams presenting five levels of proximal lesion penetration was administered to students attending the six private and three public dental schools in the state of Rio Grande do Sul, Southern Brazil. Absolute and relative frequencies were described and inferential statistics involving Chi-square and McNemar tests and simple logistic regression were carried out to assess variations in therapeutic decisions related to patient dentition (deciduous/permanent) and gender, ageand dental school (public/private). Of the 346 dental students assessed, 28.6% (99/346) indicated restorative treatment for lesions restricted to the enamel in deciduous teeth and 38.2% (132/346) indicated the same for permanent teeth, revealing a statistically significant difference (p = 0.001). Student gender and age were not associated with the therapeuticdecision; however, a signifi cant difference between dental schools was found when comparing restorative criteria in deciduous (p < 0.001) and permanent molars (p < 0.001). The odds of restorative decision in permanent teeth when the caries lesion was restricted to the enamel was 72% higher for students graduating from private schools compared to public schools (Odds Ratio: 1.72; 95% Confi dence Interval: 1.03-2.90). These data demonstrate a large variation between the therapeutic decisions regarding proximal caries reported by final-year dental students and suggest that deep refl ection is needed on the part of faculty in order to provide an evidence-based education.

Unusual case of green pigmentation in human teeth resulting from neonatal hyperbilirubinemia.

Green pigmentation in teeth is an uncommon condition that is associated with bilirubin deposits in dental hard tissues. This article presents a case involving an 8-year-old girl with green teeth associated with intrinsic pigmentation by bilirubin. The reported case confirms the relevance of a medical history in establishing a diagnosis of green pigmentation.

Tracionamento de incisivo central superior impactado utilizando a tomografia linear como método auxiliar de diagnóstico: relato de caso / Linear computed tomography as auxiliar method for diagnosis and treatment of impacted maxillary central incisor: a clinical case report

A impactação dentária é um distúrbio de erupção e, por conseqüência, um dos problemas ortodônticos observados na rotina clínica. O tratamento usualmente envolve o desafio de procedimentos cirúrgicos, ortodônticos e periodontais. Um bom diagnóstico do caso dependerá do diagnóstico precoce e da avaliação da posição e angulação dentária no alvéolo, dentre outros fatores. A apresentação deste caso clínico relata a importância do dente 21, devido a uma grave dilaceração de raiz, diagnosticada por meio de uma tomografia linear. O tratamento proposto combinou a expansão do arco superior, a técnica cirúrgica e de erupção fechada e a tração ortodôntica, além da aplicação de aparelhagem ortodôntica fixa, para o correto alinhamento do dente. Os procedimentos permitiram restabelecer com sucesso a estética e a oclusão do paciente

Utilização do sistema de anestesia computadorizada The Wand® em odontopediatria / Use of the computed anesthetic system The Wand® in pediatric dentistry

Introdução: O comportamento positivo do paciente infantil depende, entre outras variáveis, do controle da dor com a anestesia local. Objetivo: Neste contexto realizou-se uma revisão de literatura sobre a utilização da anestesia computadorizada em odontopediatria. Este sistema anestésico tem como principal objetivo reduzir o desconforto causado pela anestesia, por meio do controle de dois fatores que influenciam no sucesso da anestesia local: a pressão e o volume do l¡quido anestésico. Conclusão: A maioria dos trabalhos revisados demonstrou que o sistema computadorizado The Wand© é superior a anestesia tradicional, quando as técnicas modificadas são utilizadas.

Introduction: The positive behavior of the pediatric patient depends, among other variables, on pain control with local anesthetics.Purpose: In this context, a review of literature was performed regarding the use of computed anesthesia in Pediatric Dentistry.This anesthetic system has as its main goal minimizing the discomfort caused by conventional anesthesia, by controlling two factors that influence the success of local anesthesia: the pressure and volume of the anesthetic liquid. Conclusions: Most retrieved studies demonstrated that the computed anesthetic system The Wand© has a better performance than conventional anesthesia, when the modified techniques are used.

Evaluation of the methodologies used in clinical trials and effectiveness of chemo-mechanical caries removal with CarisolvTM

This investigation aims to discuss the methodologies applied in clinical trials published about CarisolvTM, in order to assess the best scientific evidence concerning chemo-mechanical caries removal. Papers concerning the use of CarisolvTM were sought using a search strategy. The titles and abstracts of all the reports identified through the search were analyzed by a single reviewer. The inclusion criterion involved: clinical trials having CarisolvTM in one of the study groups. Then, those that fulfilled the inclusion criterion underwent methodology assessment and data extraction. Only 12 papers met the inclusion criterion. It was observed that none of these studies complied with all the evaluated research methodological principles required in order to have power of evidence generation. CarisolvTM proved to be effective in caries removal. Appointment mean time was greater, but the perceived time was shorter than that using conventional techniques due to patients' perception of more comfort and a reduction of anesthesia needs. There were no adverse effect in long-term assessments. In studies with microbiological evaluation of the remaining dentine, it was observed that both the conventional and chemo-mechanical methods produced statistically significant reduction on counts of viable microorganisms.

Esta investigação objetiva discutir as metodologias aplicadas em ensaios clínicos publicados sobre Carisolv®, para verificar a melhor evidência científica concernente à remoção químico-mecânica de tecido cariado. Artigos referentes ao uso de Carisolv® foram procurados utilizando-se uma estratégia de busca. Os títulos e resumos de todos os estudos identificados pela procura foram analisados por um único revisor. O critério de inclusão envolveu: ensaios clínicos contendo o sistema Carisolv® em um dos grupos de estudo. Os estudos que preencheram o critério de inclusão foram submetidos à avaliação de metodologia e extração de dados. Somente 12 artigos preencheram o critério para inclusão. Foi verificado que nenhum desses estudos obedeceu a todos os princípios metodológicos considerados necessários para que uma pesquisa tenha poder de geração de evidências. O Carisolv® demonstrou ser eficaz na remoção de tecido cariado. O tempo de consulta foi maior, mas o tempo percebido foi inferior em comparação ao tempo das técnicas convencionais devido à percepção dos pacientes de mais conforto e de redução da necessidade de anestesia. Não houve efeito adverso em avaliações a longo prazo. Em estudos com avaliação microbiológica da dentina remanescente foi verificado que ambos os métodos convencional e químico-mecânico produziram redução significativa na contagem de microrganismos viáveis.