Contribuição do Pró-Saúde para a reorientação da formação em Odontologia e implementação das Diretrizes Curriculares Nacionais: estudo de casos / Contribution of Pró-Saúde to a reorientation of Dental education and implementation of the National Curricular Guidelines: case studies

O Pró-Saúde é uma iniciativa do Ministério da Saúde com a parceria do Ministério da Educação, de amplo alcance e capilaridade, instituído e implementado a partir de 2006 e voltado para a reorientação da formação profissional em Saúde. O objetivo do presente estudo foi verificar de que forma e com quais estratégias estão sendo conduzidas as mudanças curriculares em cursos de graduação de Odontologia, em universidades públicas brasileiras, inscritas neste programa. Trata-se de um estudo de casos. Foram selecionados cinco cursos de graduação, um em cada macrorregião do país, e aplicados questionários de percepção aos coordenadores ou docente representante de cada curso, e a um grupo de estudantes, sobre as mudanças em processo. Os resultados apontaram que o Pró-Saúde tem sido um efetivo instrumento indutor de mudanças na direção da implementação das Diretrizes Curriculares Nacionais (DCN). Os estágios extramuros apresentam grande variação no seu planejamento e representam uma ferramenta importante para o desenvolvimento das competências requeridas pelas DCN. Em relação à abordagem pedagógica, ainda predominam práticas tradicionais baseadas na transmissão vertical de conhecimentos e a integração das disciplinas ocorre, principalmente, em seminários modulares e disciplinas profissionalizantes (AU).

Pro Health (Pró Saúde) is an initiative of the Ministry of Health in association with the Ministry of Education, with broad coverage and capillarity. It was instituted and implemented since 2006, creating a partnership between health courses with the secretariats of Health, involving, in the beginning, the Brazilian health System (SUS) services and, more recently, involving the other services of SUS, at a national level. The objective of the present study was to verify how and with what strategies the curricular changes are being conducted in undergraduate Dentistry courses at Brazilian public universities enrolled in Pro Health. It is a case study methodology. Five undergraduate courses were selected, one in each macro region of the country, and questionnaires of perception were applied to the coordinators or teaching staff representative of each course, and to a group of students, about the changes in the process. The results pointed out that the Pro Health has been a useful instrument to induce shifts in the direction of the implementation of the National Curricular Guidelines (NCR). The extramural stages present great variation in their planning and represent an important tool for the development of the competencies required by the NCR. Regarding the pedagogical approach, traditional practices based on the vertical transmission of knowledge still predominate, and the integration of the disciplines occurs, mainly, in modular seminars and professional disciplines (AU).

Avaliação das competências dos cirurgiões dentistas que atuam nas equipes de saúde da família do município de São Paulo, na percepção dos gerentes das Unidades Básicas de Saúde / Evaluation of the competences of dentists acting in family health teams in São Paulo: the percection of managers of basic health units

O estudo objetiva a avaliação das competências dos dentistas que atuam nas Equipes de Saúde da Família (ESF) de São Paulo, Brasil na percepção dos gerentes das Unidades Básicas de Saúde (UBS) para verificar o quão estão integrados ao perfil que se busca com as Diretrizes Curriculares Nacionais (DCN) estabelecidas em 2002. Foi realizada a aplicação de questionários enviados online aos gerentes das UBS que tinham ESF atuando com dentista. Participaram da pesquisa 65 gerentes. Todas as 10 competências a serem desenvolvidas pelos dentistas foram consideradas extremamente importantes por mais de 50% dos respondentes. Os aspectos mais bem avaliados no desempenho dos dentistas foram: planejar ações integradas, planejar ações, privilegiando o caráter educativo e executar ações curativas. Os adolescentes são um grupo, ainda pouco explorados, em relação a programas de prevenção direcionados a eles. Na percepção dos gerentes respondentes, os cirurgiões dentistas estão integrados satisfatoriamente ao modelo de perfil que se busca com as DCN implantadas em 2002 (AU)

Disfunção temporomandibular na adolescência / Temporomandibular disorder in adolescence

A adolescência corresponde a um período de transição entre infância e vida adulta, caracterizado pelos impulsos do desenvolvimento físico, mental, emocional, sexual e social e pelos esforços do indivíduo em alcançar os objetivos relacionados às expectativas culturais da sociedade em que vive. Os limites cronológicos da adolescência são definidos pela Organização Mundial da Saúde entre 10 e 19 anos. Esse período é iniciado com as mudanças corporais da puberdade, terminando com a consolidação do crescimento e da personalidade dos indivíduos. As disfunções temporomandibulares (DTM) constituem um grupo de condições dolorosas que provocam dores crônicas na região da cabeça, articulação temporomandibular, músculos mastigatórios, região sub-occipital e musculatura supra-escapular. Caracterizam-se por, não apresentar obrigatoriamente patologias sintomáticas, mas alterações funcionais do sistema mastigatório. Existe classificação das mesmas, em musculares e articulares. Sinais clínicos de DTM e dor podem acometer crianças e adolescentes. Nas situações clínicas com suspeita da presença de DTM na adolescência, convém investigar sinais e sintomas, bem como fatores associados a disfunção presentes. Tal conduta tende a ser benéfica, dessa forma pode-se detectar precocemente a disfunção, impedindo agravantes na idade adulta. Objetivo: O objetivo do presente artigo foi o de realizar uma revisão de literatura acerca das manifestações da DTM na adolescência. Conclusão: Concluiu-se que uma abordagem clínica correta pode identificar e tratar manifestações da disfunção, melhorando a qualidade de vida dos pacientes acometidos...

Adolescence is a period of transition between childhood and adulthood, characterized by the impulses of the physical, mental, emotional, sexual and social and the individuals efforts to achieve the objectives related to the cultural expectations of the society in wich he lives. The chronological boundaries of adolescence are defined by the World Health Organization between 10 and 19 years. This period starts with the bodily changes of puberty, ending with the consolidation and growth of the personality of individuals. Temporomandibular disorders (TMD) are a group of painful conditions that cause chronic pain in the head, temporomandibular joint, masticatory muscles, the sub-occipital and supra-scapular muscles. Characterized by, not necessarily present pathologies symptomatic, but functional changes of the masticatory system. There is a basic classification of the same in muscles and joints. Clinical signs of TMD and pain can affect children and adolescents. In clinical situations with suspected TMD in adolescence, should investigate signs and symptoms as well as factors associated with dysfunction present. Such conduct tends to be beneficial this way you can detect early dysfunction, preventing aggravating adulthood. Aim: The purpose of this article was to conduct a literature review of the manifestations of TMD in adolescence. Conclusion: It was concluded that a correct clinical approach can identify and treat manifestations of dysfunction, improving the quality of life of affected patients...

Prevalence of signs and symptoms of temporomandibular dysfunction in female adolescent athletes and non-athletes.

OBJECTIVES: To compare the prevalence of signs and symptoms of temporomandibular dysfunction (TMD) in female adolescent athletes and non-athletes and to examine the association between signs and symptoms of TMD in female adolescents in different Tanner stages. METHODS: The subjects were 89 female basketball and handball players ages 10-18 years and 72 female non-athlete adolescents ages 10-19 years selected from the Department of Pediatrics (School of Medicine, Federal University of São Paulo) as a control group. A survey was used to assess the signs and symptoms of TMD. According to the answers on the survey the adolescents were classified in two categories: no signs or symptoms present (score A-absent), at least one sign or symptom present (score P-present). The ones who got score "P" were submitted to a standardized functional examination of the masticatory system by four previously calibrated examiners. Pubertal status was assessed based on physical examination by physicians from our Division. The adolescents were classified according to Tanner stages into three subgroups: subgroup 1 (before the growth spurt), subgroup 2 (growth spurt period), subgroup 3 (end of growth spurt). Significant differences between athletes and non-athletes were assessed for categorical variables (Chi-square and Fisher's exact test) and for continuous variables (Mann-Whitney test). The level of significance used was 5%. There was significant agreement between raters, kappa-values (0.621-1.000) and ICC values (0.757-0.899). RESULTS: There was no significant difference between the athletes and non-athletes in exhibiting at least one sign or symptom of TMD (p=0.301). When comparing the adolescents who presented at least one symptom of TMD to the different subgroups of Tanner stages no statistically significant differences were found (p=0.124). CONCLUSION: The lack of significant differences among female adolescent athletes and non-athletes and among the subgroups of Tanner stages may suggests that although contact sports increase the risk of temporomandibular joint lesions and estrogen levels are risk factor for onset of TMD, they do not impact significantly on the onset of this disorder, when considered alone.

Enamel defects in the complete primary dentition of children born at term and preterm.

PURPOSE: This study's purpose was to compare the frequency of enamel defects (ED) in the complete primary dentition (CDD) of term children (TC) and preterm children (PTC) and to analyze neonatal factors associated with ED in PTC. METHODS: The study group was formed by 45 PTC, cared for at the Follow-up Clinic for Preterm Children of the Federal University of São Paulo, Brazil. The control group included 46 school-children born at term. RESULTS: ED was more frequent in PTC (87%) than in TC (44%; P<.05). All 34 PTC with tracheal intubation at birth presented ED, showing a strong association between both. The variable was not included in the regression model. To analyze neonatal factors associated with ED in PTC, a model of logistic regression was adjusted. Malnutrition at term-corrected age increased the risk of ED in PTC 7.8 times. Opacity (white/cream) and hypoplasia (missing enamel) were frequent types of ED in this series. PTC and TC presented with high ED frequencies. CONCLUSIONS: The frequencies of enamel defects were elevated in term and preterm children, but were higher in the latter. Tracheal intubation was strongly associated with enamel defects, and extrauterine growth restriction significantly increased the risk for enamel defects in preterm children.

Prevalence of signs and symptoms of temporomandibular dysfunction in male adolescent athletes and non-athletes.

PURPOSE: The aim of the study was to compare the prevalence of signs and symptoms of temporomandibular dysfunction (TMD) in male adolescent athletes-basketball players and non-athletes and to examine the association between signs and symptoms of TMD in male adolescents in different Tanner stages. METHODS: The subjects were 46 male basketball players ages 10-13 years and 41 male adolescent non-athletes ages 10-18 years selected from the Department of Pediatrics (School of Medicine, Federal University of São Paulo) as a control group. A questionnaire was used to assess the signs and symptoms of TMD. According to the answers on the questionnaire the adolescents were classified in two categories: no signs or symptoms present (score A-absent), at least one sign or symptom present (score P-present). The ones who got score "P" were submitted to a standardized functional examination of the masticatory system by the same examiner. Pubertal status was assessed based on physical examination by physicians from our Division. The adolescents were classified according to Tanner stages into three subgroups: subgroup 1 (before the growth spurt), subgroup 2 (growth spurt period), subgroup 3 (end of growth spurt). Significant differences between athletes and non-athletes were assessed using non-parametric Wilcoxon test for continuous variables and the Fisher's exact test for categorical variables. The level of significance used was 5%. RESULTS: There was no significant difference between the athletes and non-athletes in exhibiting at least one sign or symptom of TMD (p=0.1148). When comparing the adolescents who presented at least one symptom of TMD to the different subgroups of Tanner Stages no statistically significant differences were found (p=0.8357). CONCLUSION: The lack of significant differences among male adolescents athletes and non-athletes may be caused by the size of the sample, the age of the athletes or by a probable protective action of testosterone levels in male athletes. The lack of statistical difference comparing the adolescents who presented at least one sign or symptom of TMD to subgroups of Tanner is probably because estrogen is the risk factor hormone and the levels of estrogen in male adolescents are very low.