Association between frailty and oral health services use in Brazilian older adults.

OBJECTIVES: To assess the association between frailty and oral health services use in Brazilian older adults. METHODS: This cross-sectional study analysed the baseline data from the Longitudinal Study on Brazilian Ageing (ELSI-Brazil) representative of Brazilians aged 50 or over. The outcome was oral health services used in the year prior to the interview. The main exposure variable was Frailty defined by the frailty phenotype. Age, skin colour, wealth, sex, education, type of service, health insurance, number of teeth and self-perceived oral health were included as covariates. Prevalence ratios (PR) with their respective 95% confidence intervals (CI) were estimated using Poisson regression with robust variance. RESULTS: 8405 individuals were included in this study. The prevalence of frailty was 7.5%. Regarding frailty status, the prevalence of dental service use was 47.0%, 48.5% and 4.5% for robust, pre-frail and frail individuals, respectively. Frail individuals had a 7% higher prevalence of not using dental (PR: 1.07; 95% CI: 1.01-1.13) than robust individuals. Frailty was independently associated with not using oral health services. CONCLUSION: Given the complexity of the determinants of dental service use, frailty adds another dimension to be examined in older adults. Public health strategies considering a common risk factor approach should be endorsed.

Trends in maternal oral health services at primary healthcare centers in Saudi Arabia: a cross-sectional study.

BACKGROUND: During pregnancy, many complex physiological changes and increased levels of pregnancy hormones are associated with adverse oral health and increased prevalence of periodontal disease. Our study aimed to assess the oral health needs of pregnant women and describe the patterns of dental services provided to them before, during, and after pregnancy. Assessing the oral health needs of pregnant women and understanding the patterns of dental services provided to them are important to facilitate efficient utilization of oral health services to promote better health outcomes for the mother and baby. METHODS: Our study utilized a cross-sectional design to examine the prevalence of dental problems and use of dental services among a sample of postpartum women who visited primary healthcare centers (PHCs) in Jeddah for antenatal care, between 2018 and 2019. A link to a questionnaire adapted from the Pregnancy Risk Assessment Monitoring System (PRAMS) was sent to participants via the WhatsApp messaging platform. A total of 1350 postpartum women responded to the online survey. We estimated the prevalence of dental problems among women before and during pregnancy and assessed the association between their dental problems and their respective demographic characteristics. We calculated the prevalence of each dental service received before, during, and after pregnancy and examined the trends in dental services over these three periods. All bivariate associations were tested using Pearson's chi-squared test. RESULTS: We found that significantly fewer women visited a dental clinic during pregnancy (31.0%) compared to pre-pregnancy (38.2%) and post-pregnancy (47.3%). The prevalence of toothache, dental caries, gum disease, and dental extraction need before pregnancy was 45.9%, 57.0%, 27.3%, and 40.0%, respectively. These percentages remained the same during pregnancy, except for the need for dental extraction, which significantly decreased to 35.3%. Check-up dental visits increased significantly to 70.6% during pregnancy compared to pre-pregnancy (51.7%) and post-pregnancy (59.9%). CONCLUSION: Increasing women's awareness of the importance and safety of oral healthcare during pregnancy, training dental students and primary healthcare dentists in the practice guidelines for the dental management of pregnant women, and developing and monitoring key performance indicators for maternal oral healthcare are the starting steps for improving the oral health and well-being of women and their children.

Positive impacts of oral health services provision by a student-led primary care clinic to an Australian rural indigenous community.

BACKGROUND: This study aimed to determine whether oral health services provision by a dental student clinical outplacement embedded within a Community Controlled Health Service positively impacted a rural Indigenous community and to explore the nature of these benefits. METHODS: Aggregated and de-identified 2017, 2018 and 2019 student-led clinic services provision data were retrospectively analysed. The change in services mix over time was measured. Rural outplacement clinic operational costs to the university were estimated. Government-funded local public dental clinic waiting list and services provision data were used to identify any student clinic establishment effect. RESULTS: The student-led clinic services mix shifted over time from mainly acute care for toothache towards prevention of disease and tooth restoration, indicating an improvement in patient oral health and correspondingly reduced system costs. Imputed value of 2017-2019 student-led clinic services provision totalled almost AUD$1 million. Government public clinic waiting list times decreased after full establishment of the student-led clinic, indicating decreased pressure on the public system. CONCLUSION: The Community Controlled Health Service and university partnership improved community oral health care access, its timely delivery and simultaneously provided valuable human capital development from the student training experience. The student-led clinic's targeted Indigenous community showed oral health improvement over time. © 2023 Australian Dental Association.

Associated factors of prosthetic rehabilitation in specialized dental care in Brazil: a cross-sectional study.

OBJECTIVE: This study aimed to analyze the individual and contextual factors associated with prosthetic rehabilitation in Dental Specialty Centers (DSC) in Brazil. A cross-sectional study, with secondary data from modules II and III of the External Assessment of the 2nd Cycle of the National Program for the Improvement of Access and Quality (PMAQ) of DSCs, was conducted in 2018. Individual variables considered were socioeconomic conditions and perceptions about the structure and service of the DSC. Contextual variables were related to DSC. We considered the region of the country (capital or countryside), geographic location and work process of the DSC for prosthetic rehabilitation. The association between individual and contextual variables and prosthetic rehabilitation in the DSC was analyzed by multilevel logistic regression. RESULTS: Ten thousand three hundred ninety-one users from 1,042 DSC participated. Of these, 24.4% used dental prosthesis and 26.0% performed at the DSC. In the final analysis, performed dental prostheses in the DSC individuals with less education (OR = 1.23; CI95%:1.01-1.50) and residents of the same city as the DSC (OR = 1.69; CI95%:1.07-2.66), at a contextual level, DSCs of the countryside (OR = 1.41; CI95%:1.01-1.97) were associated with the outcome. Individual and contextual factors were associated with prosthetic rehabilitation in the DSC.

Redes de atenção à saúde bucal: a transversalidade invisível / Oral healthcare networks: the invisible transversality

Resumo Este artigo discute a estruturação das redes de atenção à saúde no Sistema Único de Saúde, detalhando as principais redes temáticas prioritárias. Argumenta-se que a inserção transversal da saúde bucal nas redes prioritárias torna invisível as demandas específicas da área. Defende-se que a rede de atenção de saúde bucal possui todos os elementos para constituir-se em uma rede prioritária, com pontos de atenção e apoios logístico e diagnóstico. Conclui-se que é preciso situar o espaço de gestão da saúde bucal para além da atenção primária, de forma a fortalecer a rede e as instâncias municipais e estaduais de gestão.

Abstract This article discusses the structuring of health care networks in the Unified Health Care System, detailing the main priority thematic networks. It is argued that the transversal insertion of oral health in priority networks makes the specific demands of the area invisible. It is argued that the oral health care network has all the elements to constitute a priority network, with points of care, logistical and diagnostic support. It is concluded that it is necessary to place dental management beyond the primary health care division in order to develop a specific network, and strengthen the municipal and state dental management instances.

Atenção ao câncer bucal na região de saúde Metropolitana I do Rio de Janeiro, Brasil: fatores facilitadores e coercitivos / Oral cancer care in the "Metropolitan I" health region in the state of Rio de Janeiro, Brazil: enabling and constraining factors

Resumo O objetivo foi identificar os fatores facilitadores e coercitivos da organização da rede de atenção à saúde que intervêm sobre o acesso ao diagnóstico e tratamento do câncer bucal. Um estudo de caso da região de saúde Metropolitana I do estado do Rio de Janeiro, com coleta de dados em sistemas de informação e 26 entrevistas com gestores e profissionais. A análise dos dados foi realizada por meio das técnicas de estatística descritiva e análise temática, à luz da Teoria da Estruturação de Giddens. Identificou-se baixa cobertura de saúde bucal na atenção básica, com priorização do acesso a grupos prioritários e urgências, dificultando o acesso ao diagnóstico do câncer bucal neste nível de atenção. A presença da rede secundária em todos os municípios da região facilita o diagnóstico, porém há limites para o acesso ao tratamento. Faculdades de odontologia atuam no diagnóstico como rede informal, ação importante, mas não financiada. A regulação para o diagnóstico não foi restritiva, mas para o tratamento a regulação foi considerada pouco transparente e demorada, com falta de vagas. Apesar dos avanços, persistem fatores coercitivos estruturais e nas ações dos agentes que restringem diagnóstico e tratamento oportuno do câncer bucal.

Abstract The aim was to identify constraining and enabling factors related to the organization of health care networks that influence access to oral cancer diagnosis and treatment. A case study in the "Metropolitan I" health region using data collected from health information systems and 26 semi-structured interviews with health managers and professionals. The data were analyzed using descriptive statistics and strategic conduct analysis, drawing on the theory of structuration proposed by Giddens. The findings reveal that coverage of oral health care in primary care services is generally low and prioritizes specific groups and urgent cases, hampering access to oral cancer diagnosis. While the presence of a network of secondary care services in the municipalities that make up the health region facilitates diagnosis, there are major barriers to treatment. Informal partnerships established with dental schools play an important role in diagnosis, but do not receive funding. The regulation of appointments for diagnosis was not restrictive. In contrast, the regulation of referrals for treatment lacked transparency, was subject to long delays, and shortage of places. Despite advances, constraining factors related to structure and the actions of agents involved in the care process persist, hampering the timely diagnosis and treatment of oral cancer.

Current oral health services and the divergent needs of the baby boom cohorts.

The two cohorts of Baby Boomers, the Early (born between 1945 and 1955) and the Late (born between 1956 and 1964), have some subtle yet distinct differences when it comes to their oral health and oral health related behaviors. Unlike their predecessors, the Baby Boomer cohorts are retaining more teeth, as there is a sharp fall in edentulous rates in this population. The oral health care community is now facing unparalleled challenges in providing and maintaining the oral health of this unique cohort who are keeping their teeth longer, have multiple comorbidities, and are living longer than previous generations. This paper draws from the latest studies, scientific data and research to describe a realistic picture of the oral health services available to and utilized by the Baby Boomers. The factors affecting utilization, their rising needs, demands, expectations, and areas where improvement is needed for the Baby Boomer are also reported here.

The effects of Medicaid expansions on dental services at federally qualified health centers.

BACKGROUND: Federally qualified health centers (FQHCs) have become safety-net providers of dental services for low-income patients. The authors examined the effects of the Patient Protection and Affordable Care Act Medicaid expansions, according to level of dental benefits, on the number of visits for dental services at FQHCs. METHODS: The authors used publicly available facility-level data on 1,400 FQHCs across the United States from the 2011 through 2019 Uniform Data System. The authors used an event-study difference-in-difference design to examine the effects of expanding Medicaid in 2014, according to the level of dental benefits, compared with nonexpansion states. Outcomes included the number of dental visits for any dental service and separately for preventive and other services. Regression models adjusted for the demographic characteristics of the FQHC's patient population, county-level factors, and center and year fixed effects. RESULTS: Expanding Medicaid with extensive dental benefits has increased the number of dental visits provided at FQHCs in 2014 through 2019 from 2013 by 1,329 to 7,647 visits per FQHC on average compared with FQHCs in nonexpansion states. There was an increase in visits for both preventive and other dental services. In contrast, there was no evidence of such an increase from expanding Medicaid with limited or emergency-only dental benefits. CONCLUSIONS: Expanding Medicaid eligibility with extensive dental benefits has increased the number of dental visits at FQHCs, including for both preventive and other dental services. PRACTICAL IMPLICATIONS: As safety-net providers, FQHCs might be able to provide more oral health care for low-income patients after Medicaid expansions that offer extensive dental benefits.

Adherence to individualized recall intervals for oral health examinations.

OBJECTIVES: The aim of this follow-up study was to investigate whether adults attend an oral health examination (OHE) based on their individual recall interval (IRI) without a reminder recall system. METHODS: The study population included adults who were attending an OHE recommended by their dentists based on their IRI in public oral healthcare clinics of Helsinki City January 1, 2009-December 31, 2009. The inclusion criteria were as follows: alive until the end of IRI, length of the IRI of 12-60 months, and study participants had not been treated successfully by a dental specialist during the IRI period (n = 41,255). We used a multinomial model to identify the factors associated with the timing of OHE. The following predictors were included: oral health indices such as Decayed Teeth and the Community Periodontal Index, the length of the IRI based on an OHE in 2009, age, gender, socioeconomic status, presence of chronic diseases, and emergency appointment. Results were presented as odds ratios with 95% confidence intervals. RESULTS: The OHE based on IRI occurred for 7505 individuals (18.2%) and the OHE was late for 9159 individuals (22.2%). A total of 24,591 (59.6%) adults did not undergo follow-up OHE based on the IRI period of on time or late. Those who came on time for follow-up OHE experienced less caries than those who came later. There was not much difference in periodontal health between the groups. The models indicated that having an emergency appointment was associated with a higher probability of having an OHE. A long IRI (37-60 months) was associated with a higher probability of not participating in OHE even late. CONCLUSIONS: It would be beneficial for patients to take appointments based on the recall interval. The results of this study indicated that more needs to be done to increase awareness in the adult population of the benefits and availability of follow-up OHEs based on their IRI in oral healthcare.

Oral health status, treatment needs, and patterns of utilization of dental services among village volunteers in Andhra Pradesh: A cross-sectional multi-stage cluster survey.

Background: Community health depends on the leadership duties of a diverse population, such as village volunteers. Hence, a study was conducted to assess oral health status, treatment needs, and patterns of utilization of dental services among village volunteers in Andhra Pradesh state. Methodology: A cross-sectional study was conducted among 400 village volunteers in Andhra Pradesh state, India. A multi-stage cluster sampling procedure was employed in sample selection. A questionnaire was used to review the pattern of utilization of dental services. World Health Organization Oral Health assessment form 1997 was used to evaluate oral health status and treatment needs. Data collected were analyzed using IBM SPSS Statistics for Windows, Version 25.0. Descriptive statistics were done. Results: Out of 400, 18% had never visited the dental clinic in their lifetime. The majority (33.5%) considered that dental problems were not a serious concern. Dental caries was seen in 69.5%, and 78.5% were presented with periodontal conditions. About 19.8% and 24.3% had crowding and spacing in incisal segments, respectively. The prevalence of oral mucosal disorders and dental fluorosis was 4.25% and 8.75%, respectively. Overall, 94% of the study participants needed dental treatment for various reasons. Conclusion: This study provides sufficient evidence to conclude that this population's oral health was poor, with increasing unmet dental treatment needs. Selected interventions and strategies should focus on these factors to decrease the burden of oral diseases among village volunteers.

Análise das condutas estratégicas de gestores e profissionais para a prevenção e o controle do câncer bucal / Analysis of the strategic conduct of managers and professionals involved in oral cancer prevention and control

Resumo Gestores e profissionais de saúde são os agentes responsáveis pela implementação das políticas públicas nos serviços de saúde, sendo de fundamental importância compreender as formas como agem no cotidiano. O objetivo desta pesquisa é analisar as condutas estratégicas de gestores e profissionais que intervêm na prevenção e no controle do câncer bucal. Trata-se de pesquisa qualitativa, realizada por meio de 23 entrevistas com gestores e profissionais de cinco municípios da região de saúde Metropolitana I do Rio de Janeiro e três entrevistas com o corpo técnico estadual. Realizou-se a análise da conduta estratégica prevista na Teoria da Estruturação de Giddens. Verificou-se que esses agentes, sensibilizados pelas representações do câncer na sociedade, se mobilizam como potenciais agentes facilitadores do acesso e criam alternativas informais aos protocolos mais restritores. No entanto, essa mobilização não costuma ocorrer no período anterior à suspeita do câncer, constituindo uma contradição importante. Destacou-se a importância da ampliação da atenção primária e do aperfeiçoamento das ações de promoção da saúde, prevenção do câncer e educação permanente para garantia do direito ao acesso ao diagnóstico e tratamento precoce do câncer bucal.

Abstract Health managers and professionals are the agents responsible for implementing public policies in health services. It is therefore essential to understand how they act in everyday practice. The aim of this study was to analyze the strategic conduct of managers and professionals involved in oral cancer prevention and control. We conducted a qualitative study based on 23 interviews with oral health managers and professionals in five municipalities in the Metropolitana I health region in the state of Rio de Janeiro and three interviews with members of the oral health technical team of the state health department. We performed a strategic conduct analysis drawing on Anthony Giddens' theory of structuration. The findings show that, sensitized by the representation of cancer in society, these agents act as potential facilitators of access to services, creating informal alternatives to more restrictive protocols. However, this mobilization only tends to occur in cases of suspected cancer, constituting an important contradiction. It is concluded that it is essential to improve access to primary care, enhance health promotion and cancer prevention actions, and promote continuing training to guarantee the right to early diagnosis and timely treatment of oral cancer.

Manual instrucional para o coordenador municipal de saúde bucal iniciante na gestão: projeto de desenvolvimento / Instructional manual for the municipal oral health coordinator beginning in management: development project

O Sistema Único de Saúde (SUS) constitui-se por um conjunto de ações e serviços prestados por órgãos e entidades das três esferas governamentais, pelas administrações diretas ou indiretas e por fundações mantidas pelo Governo. No município, cabe ao Coordenador de Saúde Bucal (CSB) a organização e supervisão da atenção à saúde bucal. O CSB enfrenta diversos desafios, entre eles, o perfil de sua equipe e o financiamento insuficiente para ações e projetos. A gestão torna-se mais árdua quando o gestor apresenta pouca ou nenhuma experiência na gestão pública na área da saúde. Com base na ciência da Pesquisa de Implementação (PI), este projeto de desenvolvimento teve como objetivo elaborar um Manual Instrucional para profissionais que ocupam cargos de gestão da atenção à saúde bucal, em municípios do Estado de Minas Gerais, pertencentes à Gerência Regional de Saúde de Itabira (GRS-Itabira), composta por 24 municípios. Entre os 24 municípios, apesar de todos terem sido convidados a participar, 11 não puderam ou não desejaram participar e 13 participaram de todas as etapas do estudo que comportou três fases: Primeira, sensibilização dos sujeitos da pesquisa e diagnóstico sobre o contexto político-organizacional na área da saúde dos municípios envolvidos e da gestão da saúde bucal. O diagnóstico foi realizado por meio de um questionário estruturado respondido pelos gestores da atenção à saúde bucal dos municípios. Segunda, fase de pré-implementação quando, por meio de grupos focais e com análise de conteúdo das falas dos sujeitos, foram avaliadas as quatro dimensões que compõem os desfechos relacionados à implementação do manual instrucional: aceitabilidade, adoção, adequabilidade e validade. Além desse objetivo foi possível identificar os anseios, os desafios, as dificuldades enfrentadas pelos gestores da saúde bucal em relação ao processo de trabalho e implementação da Política Nacional de Saúde Bucal. Também foram identificadas as condições facilitadoras e barreiras para a implantação do manual. Na terceira fase, a partir das contribuições dos grupos focais foi elaborado um manual instrucional para Coordenadores de Saúde Bucal dos municípios, principalmente aqueles com nenhuma ou pouca experiência na gestão dos serviços púbicos de saúde. Após finalizado, na forma de um e-book, o manual será disponibilizado para os gestores que participaram do processo de sua elaboração. Quanto à sua efetiva implementação e benefícios, será necessário um estudo posterior a este projeto que considere as etapas da Implantação e Avaliação considerando as etapas da Pesquisa de Implementação.

The Unified Health System (SUS) consists of a set of actions and services provided by bodies and entities from the three spheres of government, by direct or indirect administrations and by foundations maintained by the Government. In the municipality, it is up to the Oral Health Coordinator (CSB) to organize and supervise oral health care. The CSB faces several challenges, including the profile of its team and insufficient funding for actions and projects. Management becomes more arduous when the manager has little or no experience in public management in the health area. Based on the science of Implementation Research (IP), this development project aimed to prepare an Instructional Manual for professionals who occupy management positions in oral health care, in municipalities in the State of Minas Gerais, belonging to the Regional Health Management Itabira (GRS-Itabira), comprising 24 municipalities. Among the 24 municipalities, although all were invited to participate, 11 were unable or unwilling to participate and 13 participated in all stages of the study, which comprised three phases: first, raising awareness of the research subjects and diagnosis of the political-organizational context in the health area of the municipalities involved and the management of oral health. The diagnosis was carried out through a structured questionnaire answered by the managers of oral health care in the municipalities. Second, the pre-implementation phase when, through focus groups and content analysis of the subjects' statements, the four dimensions that make up the outcomes related to the implementation of the instructional manual were evaluated: acceptability, adoption, suitability and validity. In addition to this objective, it was possible to identify the desires, challenges, difficulties faced by oral health managers in relation to the work process and implementation of the National Oral Health Policy. Facilitating conditions and barriers to the implementation of the manual were also identified. In the third phase, based on the contributions of the focus groups, an instructional manual was prepared for Oral Health Coordinators in the municipalities, especially those with little or no experience in managing public health services. Once finalized, in the form of an e-book, the manual will be made available to the managers who participated in the process of its elaboration. As for its effective implementation and benefits, it will be necessary a study after this project that considers the stages of Implementation and Evaluation considering the stages of Implementation Research.

Vigilância da dor de dente no Brasil: um estudo a partir dos dados do SISAB / Toothache surveillance in Brazil: a study based on SISAB data

Esta dissertação foi desenvolvida como parte de uma pesquisa de avaliação de serviços de saúde bucal no nível da Atenção Primária à Saúde (APS), que criou uma matriz avaliativa de indicadores e ferramentas digitais para o monitoramento dos serviços usando dados rotineiros do atendimento dos usuários no sistema público de saúde e disponibilizados no Sistema de Informação em Saúde para a Atenção Básica (SISAB). O produto científico é um artigo proveniente do estudo ecológico de âmbito nacional que análisou a morbidade atendida por dor de dente por porte populacional dos municípios brasileiros (2018 a 2022). O indicador taxa de atendimento odontológico por dor de dente (por 1000 usuários) foi calculado para cada município brasileiro, em 15 quadrimestres (Q1-2018 a Q3-2022) e segundo o porte populacional (< 5 mil; 5 a 9,9 mil; 10 a 49,9 mil; 50 a 99,9 mil; > 100 mil habitantes). Modelo de regressão para dados longitudinais estimou a variação quadrimestral ao longo do tempo por porte populacional antes e após o Q2-2020, pois houve um padrão de redução da taxa até este momento. Foram analisados os registros obtidos de 5.332 municípios (95,72%). A taxa média de atendimento por dor de dente (por 1000 usuários) variou de 9,65 (Q2-2020) a 27,24 (Q1-2018). Em todo o período, municípios de maior porte apresentaram as menores taxas. Antes do Q2-2020, a taxa média nos municípios com >100 mil hab. apresentou uma redução quadrimestral média de 20,56%, maior do que a variação de 7,25% dos nos municípios de < 5 mil hab. Após o Q2-2020, a taxa dos municípios < 5 mil hab. aumentou 2,27%, valor menor do que a variação nos municípios de maior porte. Em média, foram realizados de 10 a 30 atendimentos por dor de dente em 4 meses para 1000 usuários cadastrados no Brasil, com as maiores taxas nos municípios de menor porte. Houve uma redução geral nas taxas até o Q2-2020, coincidindo com a suspensão dos serviços de saúde bucal devido à pandemia de COVID-19, sendo essa redução mais acentuada nos municípios de maior porte. Após esse período, o crescimento das taxas foi menos pronunciado, especialmente nos municípios de pequeno porte. A dissertação apresenta também a matriz avaliativa sistematizada como um Dicionário de Indicadores e as ferramentas digitais desenvolvidas como produto técnico. O dicionário descreve o referencial para desenvolvimento da matriz e as fichas de qualificação dos 54 indicadores mensuráveis com dados do SISAB. O Painel de Indicadores para o Monitoramento dos Serviços de Saúde Bucal na APS é uma ferramenta interativa com automatização da obtenção dos dados, cálculo dos 54 indicadores tempestivamente e demonstração de resultados por regiões, Unidades da Federação e municípios brasileiros, por meio de tabelas, gráficos e mapas, com filtros geográficos e temporais. A Calculadora de Indicadores de Saúde Bucal buscou superar a lacuna da obtenção dos indicadores no nível das eSB, usando relatórios gerenciais locais. Os resultados da taxa de atendimento odontológico por dor de dente na APS sinalizam a persistência deste agravo nos serviços públicos de saúde.

This dissertation was developed as part of research to evaluate oral health services at the Primary Health Care (PHC) level, which created an evaluation matrix of indicators and digital tools for monitoring services using routine data from users' care in the public health system and made available in the Health Information System for Primary Care (SISAB). The scientific product is an article from a nationwide ecological study that analyzed morbidity due to toothache by population size in Brazilian municipalities (2018 to 2022). The indicator rate of dental care due to toothache (per 1000 users) was calculated for each Brazilian municipality, in 15 four months (1st quarter of 2018 to 3rd quarter of 2022) and according to population size (< 5 thousand; 5 to 9, 9 thousand; 10 to 49.9 thousand; 50 to 99.9 thousand; > 100 thousand inhabitants). Regression model for longitudinal data estimated the four-monthly variation over time by population size before and after the second quarter of 2020, as there was a pattern of rate reduction up to this point. Records obtained from 5,332 municipalities (95.72%) were analyzed. The average toothache attendance rate (per 1000 users) ranged from 9.65 (2nd quarter of 2020) to 27.24 (1st quarter of 2018). Throughout the period, larger municipalities received lower rates. Before the second quarter of 2020, the average rate in municipalities with >100 thousand inhabitants. presented an average quarterly reduction of 20.56%, greater than the 7.25% variation in our municipalities with < 5 thousand inhabitants. After the second quarter of 2020, the rate of municipalities < 5 thousand inhabitants. increased by 2.27%, a value lower than the variation in larger municipalities. On average, 10 to 30 consultations for toothache were provided in 4 months for 1000 registered users in Brazil, with the highest rates in smaller municipalities. There was a general reduction in rates until the second quarter of 2020, coinciding with the suspension of oral health services due to the COVID-19 pandemic, with this reduction being more pronounced in larger municipalities. After this period, rate growth was less anticipated, especially in small municipalities. The dissertation also presents the evaluation matrix systematized as a Dictionary of Indicators and the digital tools developed as a technical product. The dictionary describes the framework for developing the matrix and the qualification sheets for the 54 indicators measurable with SISAB data. The Indicator Panel for Monitoring Oral Health Services in PHC is an interactive tool with automated data collection, calculation of 54 indicators in a timely manner and demonstration of results by regions, Federation Units and Brazilian municipalities, through tables, graphs and maps, with geographic and temporal filters. The Oral Health Indicator Calculator sought to overcome the gap in providing indicators at the eSB level, using local management reports. The results of the rate of dental care for toothache in PHC indicate the persistence of this problem in public health services.

Factors associated with recent and regular non-use of dental services by students from a university in southeastern Brazil: a cross-sectional study.

BACKGROUND: Lack of use of dental services can be a risk factor for oral health. In addition to recent visits to dental services, it is important to assess the regularity of use of these services, as well as the motivations for visiting the dentist. There is a gap in literature studies on the patterns of use of oral health services by the young university students. The goal of this study was to assess the factors associated with recent and regular non-use of dental services by young university students, using the Andersen model as a reference. METHODS: This was a cross-sectional study with 477 university students between 18 and 24 years old, carried out as a web survey, through which predisposing, enabling and need variables were collected, according to the model proposed by Andersen, to test the factors associated with recent and regular non-use of dental services. Bivariate analyses and robust Poisson regression were performed, with estimation of crude and adjusted prevalence ratios, using confidence intervals of 95%. The variables with p < 0.05 remained in the final model. RESULTS: The prevalence of recent non-use was of 19.5% (95% CI 16.0-23.3%), and of regular non-use, of 53.5% (95% CI 48.9-58.0%). After the adjusted analysis, the following were found to be associated with the outcome of recent non-use: type of service used (PR = 0.91; 95% CI 0.85-0.98) and perceived need for dental treatment (PR = 0.98; 95% CI 0.97-0.99); and the following variables were associated with regular non-use: father's level of education (PR = 0.86; 95% CI 0.78-0.96), area of study (PR = 1.08; 95% CI 1.02-1.15), reason for last dental appointment (PR = 0.81; 95% CI 0.75-0.88), use of dental services throughout childhood (PR = 0.92; 95% CI 0.86-0.97), self-perceived oral health (PR = 0.86; 95% CI 0.76-0.88), and toothaches over the last 2 years (PR = 0.93; 95% CI 0.87-0.99). CONCLUSION: The motivation for young university students to use dental services are curative treatment needs, not prevention. The results point to the need to implement health prevention and promotion policies in higher education institutions and to expand access to dental services for this young population.

Mapping accessibility to oral health care in coastal India - A geospatial approach using a geographic information system (GIS).

Background: It is imperative to have a thorough assessment of the existing distribution of oral healthcare facilities and understand potential accessibility when planning for expansion of oral health services. In the present study, an attempt to measure geographic accessibility to oral healthcare, by locating the availability of dental practitioners in the coastal districts of Karnataka state, India using a geographical information system (GIS), has been made. Methods: For the study, data on public and private oral health centres were collected for the three coastal districts of Karnataka state, India. Population and income data were collected, along with geographic attributes (latitudes and longitudes) of the practitioners' addresses. Descriptive statistical analyses and dentist-to-population ratios (D:P) were calculated. Correlation between the number of clinics with population and D:P with per capita income were analyzed using Pearson's correlation coefficient. Chi-square test applied to analyze any association between D:P and urbanization. Results: Among 340 clinics, 8.5% are public and 91.5% are private clinics catering to a population of 4,704,179. Average D:P for the three coastal districts is 1:13,836. There is an uneven urban-rural distribution of dentists with lower D:P in rural areas. Rural population in four taluks have only one dentist for over a lakh population. Six taluks have only one dentist for every 50000 - 100000 population in rural areas. Six rural areas had only public centers to cater to their oral health.   Conclusions: From the study, it is concluded that oral health services were concentrated in areas with higher annual income per-capita, increased urbanization and population density.

Sistemas de informação utilizados para planejamento e avaliação em saúde bucal / Information systems used for planning and evaluation in oral health

Objetivo: Analisar os diferentes Sistemas de Informação em Saúde utilizados para planejamento e avaliação em saúde bucal no Brasil. Método: Realizou-se uma revisão integrativa, por meio de busca das publicações em março de 2019, a partir da Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Bibliografia Brasileira de Odontologia (BBO), Medical Literature Analysis and Retrieval System Online (MEDLINE) e Coleciona SUS. A categorização para definir os núcleos de sentidos dos estudos teve como referência a análise temática de Minayo. Resultados: A categorização resultou em três grandes áreas temáticas: O perfil social e/ou econômico do usuário da atenção à saúde bucal, a cobertura,b em como o uso de indicadores de saúde bucal, e as limitações quanto ao uso dos Sistema de Informação em Saúde(SIS). Conclusão: Observou-se que os SIS auxiliaram na gestão das informações e nos processos de tomadas de decisão, servindo de instrumento de planejamento e avaliação das ações em saúde bucal

Objective: To analyze the different Health Information Systems (HIS) used in Brazil. Method: An integrative review, through search of publications in March 2019, was from the Latin American and Caribbean Literature on Health Sciences (LILACS), Brazilian Bibliography of Dentistry (BBO), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Coleciona SUS. The categorization to define the sense nucleus of the studies had as reference the thematic analysis of Minayo. Results: The categorization resulted inthree major thematic areas: The social and/or economic profile of the users of oral health care, coverage as well as the use of oral health indicators and the limitations on the use of Health Information Systems. Conclusion: It was observed that HIS assisted in information management and in decision-making processes, serving as an instrument for planning and evaluating oral health actions.

Desigualdades no perfil de utilização de serviços odontológicos no Brasil / Inequalities in the profile of using dental services in Brazil

Resumo Este trabalho teve por objetivo analisar a influência de fatores socioeconômicos na desigualdade de utilização de serviços odontológicos na população brasileira. A metodologia baseou-se em um estudo seccional, com uso de dados secundários provenientes da Pesquisa Nacional de Saúde (PNS) 2013. O banco de dados utilizado contém informações sobre 60.202 indivíduos maiores de 18 anos. As variáveis dependentes avaliadas foram "frequência de consulta odontológica" e "tipo de tratamento odontológico realizado na última consulta. As variáveis independentes avaliadas foram sexo, faixa etária, escolaridade, classe social mensurada através do critério Brasil e região geográfica. Na análise multivariada, foram avaliadas as odds-ratio dos desfechos a partir de um modelo de regressão logística multinominal. Percebeu-se que a população de cor/raça negra, residente na região Norte/Nordeste, de menor classe social e escolaridade apresentou maior chance de realizar acompanhamento irregular e nunca ter ido ao dentista. Além disso, este estrato populacional também apresentou maior chance de realizar procedimentos odontológicos cirúrgicos ou de urgência na última consulta odontológica. Os dados da PNS 2013 demonstram um quadro de desigualdade social no acesso a serviços odontológicos no Brasil.

Abstract This study aimed to examine the influence of socioeconomic factors on inequality in the use of dental services within the Brazilian population. The methodology was based on a sectional study, using secondary data from the 2013 National Health Survey (PNS, in Portuguese). The database contains information on 60,202 individuals over 18 years of age. The dependent variables were "frequency of dental appointments" and "type of dental treatment performed in the last appointment". The independent variables were sex, age group, education, social class measured using the Brazil criterion, and geographic region. The odds-ratio of outcomes were evaluated in the multivariate analysis using a multinomial logistic regression model. It was noticed that the population subgroups comprising Blacks and those residing in the North/Northeast, with lower social class and education, had a greater chance of having irregular follow-up and never having been to the dentist. In addition, this population stratum also had a greater chance of undergoing surgical or emergency dental procedures in the last dental appointment. Data from the 2013 PNS reveal a picture of social inequality in access to dental services in Brazil.

Oral Health Service Access in Racial/Ethnic Minority Neighborhoods: A Geospatial Analysis in Washington, DC, USA.

Previous studies on individual-level variables have improved our knowledge base of oral health service use. However, environmental or contextual variables are also important in understanding oral health disparities in racial and ethnic neighborhoods. Based on Bronfenbrenner's ecological framework, this study examines the geographic availability of oral health providers in Washing-ton DC, U.S.A. Census tract-level data were drawn from the American Community Survey, joined with tract-level shapefiles, and overlaid with the geographic location of dental services throughout the city. Visual maps, descriptive statistics, and spatial lag regression models showed that census tracts with higher concentrations of African Americans were significantly farther from their nearest oral health providers (r = 0.19, p < 0.001), after controlling for neighborhood poverty rate, median age, and gender. Such findings confirm that in urban areas with highly di-verse populations such as Washington DC, racial disparities in oral health care access are signifi-cant. The study highlights that identifying neighborhoods with limited oral health care providers should be a priority in diminishing racial disparities in oral health service access. Improving access to racial/ethnic minority communities, especially African American neighborhoods, will require changes in health policies and programs, workforce development, resource allocation, community outreach, and educational programs.

Informal caregivers' perceptions of oral care and their association with the use of oral health services: A cross-sectional study among informal caregivers and their care recipients.

OBJECTIVE: This study aimed to describe informal caregivers' perceptions of the importance of oral care and investigate the association between these perceptions and the use of oral health services during the past year. BACKGROUND: There is limited research on informal caregivers' perceptions of oral care. These perceptions presumably influence oral self-care along with caregivers' and care recipients' use of oral health services. MATERIALS AND METHODS: Baseline data from the multidisciplinary Lifestyle, Nutrition, and Oral health in caregivers (LENTO) intervention study were analyzed. Informal caregivers (n = 125) and care recipients (n = 120) ≥$\ge $ 65 years of age and living in Eastern Finland participated in the study. Data were collected through semi-structured interviews. RESULTS: A majority (81%) of the informal caregivers considered oral care very important. Informal caregivers who considered oral care very important had 10 or more years of education, and considered service fees reasonable were more likely to have visited oral health services during the past year than other caregivers. No association between informal caregivers' perceptions of oral care and care recipients' use of oral health services during the past year was observed. CONCLUSIONS: The study provides insight into informal caregivers' perceptions of oral care, with most informal caregivers considering oral care to be very important. Our findings support what has been reported in previous studies in that favorable perceptions of oral care are associated with oral health service visits. This association, however, did not hold true for care recipients' use of services.

The Big Five personality traits and regularity of lifetime dental visit attendance: evidence of the Survey of Health, Ageing, and Retirement in Europe (SHARE).

BACKGROUND: Regular dental visits are essential for the prevention, early detection and treatment of worldwide highly prevalent oral diseases. Personality traits were previously associated with treatment compliance, medication adherence and regular doctor visits, however, the link between personality traits and regular dental visit attendance remains largely unexplored. Thus, the objective of this study is to clarify this link. METHODS: Data (wave 7) of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used, focusing on Germany (n = 2822). Personality was assessed using the 10-item Big Five Inventory (BFI-10). Regular dental visits were assessed. Multiple logistic regressions were used, adjusting for various covariates. RESULTS: Majority of the participants (84%) reported to attend regular dental visits during lifetime. Regularity of lifetime dental visit attendance was positively and significantly associated with increased extraversion [OR 1.13, 95% CI (1.01-1.26)], increased conscientiousness [OR 1.26, 95% CI (1.10-1.44)], and increased openness to experience [OR 1.12, 95% CI (1.01-1.26)]. However, there was a lack of association with agreeableness and neuroticism. Moreover, the outcome measure was positively associated with younger age, being female, born in Germany, being married, higher education, being retired (compared to being homemaker), whereas it was not associated with obesity or chronic diseases. CONCLUSIONS: Identification of personality traits that are associated with regular dental visits can support prevention, screening and clinical management of oral diseases. Further research in this field may facilitate the development and increase the incorporation of individualized concepts to enhance patient compliance and attendance, and thus the provision of oral and dental care services.