Household food insecurity, dental caries and oral-health-related quality of life in Brazilian Indigenous adults / Insegurança alimentar domiciliar, cárie dentária e qualidade de vida relacionada à saúde bucal em Indígenas adultos brasileiros

Abstract Food insecurity is a complex phenomenon that affects the health and wellbeing of vulnerable families. The aim of this study was to investigate the relationship between household food insecurity, dental caries, oral health-related quality of life, and social determinants of health among Indigenous adults. A cross-sectional study was conducted among Kaingang adults aged 35-44 years old from the Guarita Indigenous Land, Brazil. Food insecurity was assessed through the EBIA scale. Dental caries was assessed using the DMFT index. Participants answered the OHIP-14 questionnaire and a structured interview. Descriptive and multivariate analyzes using Poisson regression models were performed. The final sample included 107 adults from 97 households. Approximately 95% lived in food insecure families. Severe food insecurity was present in 58% of the households. The phenomenon was associated to the Bolsa Família benefit, household size, and greater perception of oral health impacts on quality of life. The high number of families affected by food insecurity reveals the social vulnerability of the Kaingang people. Food insecurity in Kaingangs adults is associated to oral health perception and social determinants of health.

Resumo Insegurança alimentar é um fenômeno complexo que afeta a saúde e o bem-estar de famílias vulneráveis. Este estudo objetivou investigar a relação entre insegurança alimentar domiciliar, cárie dentária, qualidade de vida relacionada à saúde bucal, e determinantes sociais de saúde entre indígenas adultos. Foi conduzido um estudo transversal com adultos Kaingang entre 35-44 anos da Terra Indígena Guarita, Brasil. Insegurança alimentar foi avaliada pela escala EBIA. Cárie dentária foi avaliada pelo índice CPOD. Participantes responderam o questionário OHIP-14 e uma entrevista estruturada. Foram realizadas análises descritivas e multivariadas usando modelos de regressão de Poisson. A amostra incluiu 107 adultos Kaingang de 97 domicílios. Aproximadamente 95% dos participantes viviam em famílias com insegurança alimentar. Insegurança alimentar grave esteve presente em 58% dos domicílios. O fenômeno foi associado ao Bolsa Família, densidade familiar e percepção dos impactos da saúde bucal na qualidade de vida. O alto número de famílias afetadas pela insegurança alimentar revela a vulnerabilidade social do povo Kaingang. Insegurança alimentar em adultos Kaingang está associada à percepção da saúde bucal e determinantes sociais da saúde.

Association between Oral Health Literacy and Socioeconomic Variables in Users of Centers for Dental Specialties

ABSTRACT Objective: To test possible associations between Oral Health Literacy (OHL) level and socioeconomic covariates among users of Centers for Dental Specialties (CEOs). Material and Methods: The Health Literacy in Dentistry (HeLD-14) instrument was applied to 130 adult users of CEOs located in 13 municipalities in the state of São Paulo - Brazil, as well as socioeconomic issues. The researcher applied instruments in a specific room after randomly selecting individuals in the waiting room and invitation acceptance. Each item was ranked on a 5-point scale, ranging from 0 to 4, in which high scores indicate minimal difficulties in performing functions (high OHL) and low scores indicate very limited abilities to perform functions (low OHL). Statistical analysis using the Levene test was used to verify the possibility of using the one-way ANOVA test, and in case results show positive values (p>0.05), the Kruskal Wallis test was used. Results: The average age of participants was 45 years, with more than half being female (68.7%) with 9-11 years of schooling (48.4%). When considering the total value of HeLD-14 questions, OHL was associated with covariates schooling, marital status and family income. Conclusion: OHL levels were associated with socioeconomic variables, contributing to evidence in this field of specialized care.

Oral Cancer Screening in Elderly in Sao Paulo State, Brazil (2001 to 2009)

Objective: To describe and explore analytically the trends of oral cancer positive cases incidence during nine-year screenings campaign of Sao Paulo´s State (Brazil) and to show other countries and health services an option for tracking at-risk population. Material and Methods: Secondary official data were tabulated and analysed using the Excel and STATA statistical 10.0 software packages. After descriptive statistics, the trend curves were calculated by moving average for each variable (type moving average of two samples centred) to attenuate the random variability of the series, and trends classified: stable, ascending and descending. Results: The trend of municipalities numbers remained stable; the number of examined people, the screening coverage and the absolute number of patients referred to secondary health care showed an increasing trend; and the percentage of suspected cases showed a decreasing trend during the nineyear period. A decrease in the number of suspicious lesions and confirmed cases of oral cancer among the volunteers was observed, and the reorganization of secondary and tertiary levels of oral care helped to modify these numbers. Conclusion: We believe this experience was more important to help health services organization than for the oral cancer diagnosis itself, and it might be used to inspire other countries and oral health services.

Conditional factors for untreated caries in 12-year-old children in the city of Sao Paulo

The aim of the study was to analyze what sociodemographic and economic variables were associated with the presence of untreated caries in 12-year-old children in the city of São Paulo. This cross-sectional study had a complex sample design. It was based on secondary data generated by the Levantamento epidemiológico em saúde bucal (Epidemiological Oral Health Survey) in the city of São Paulo, conducted in 2008, whose sample comprised 4,246 12-year-old children from the public and private schools of all the administrative districts of the city. A questionnaire was applied and an epidemiological exam was performed in accordance with the World Health Organization's (WHO) recommendations. The variables of interest were categorized into a dependent variable of untreated dental caries (carious component of the DMFT index that corresponds to carious, missing and filled teeth) and independent variables related to the socioeconomic and demographic conditions of the children and their families, and to their access to dental services. The EPI-INFO 06 and STATA 10 programs were used for the analysis; the prevalence ratio and a confidence interval of 95% were applied to the population parameters. The Poisson regression model was used, adjusted for sampling of the complex type. Caries was associated with ethnicity (higher rate in black people, p = 0.042), attending public school (p = 0.000), lower average family income (p = 0.002), overcrowded dwellings (p = 0.000) and presence of pain (p = 0.000). Caries is a multifactorial disease influenced by social health determinants that intensify its risk.

Estratégias e resultados da prevenção do câncer bucal em idosos de São Paulo, Brasil, 2001 a 2009 / Strategies and results of the oral cancer prevention campaign among the elderly in São Paulo, Brazil, 2001 to 2009

OBJETIVO: Descrever estratégias e resultados da campanha de diagnóstico precoce e prevenção do câncer bucal para a população com 60 anos ou mais desenvolvida desde 2001 no Estado de São Paulo. MÉTODOS: A partir de documentos publicados pelo Ministério da Saúde, Instituto Nacional de Câncer, Secretaria de Estado da Saúde de São Paulo, Fundação Oncocentro de São Paulo, Secretaria Municipal da Saúde de São Paulo, Faculdade de Saúde Pública da Universidade de São Paulo e Casa de Saúde Santa Marcelina, procurou-se evidenciar a problemática do câncer bucal e apresentar as principais estratégias utilizadas para desenvolver a campanha. Ainda, avaliou-se o impacto da campanha na incidência de casos novos de câncer bucal entre os examinados. RESULTADOS: Em 2001, foram examinados 90 886 idosos, contra 629 613 idosos em 2009. As estratégias identificadas foram: capacitação dos profissionais, desenvolvimento de material impresso para orientar os municípios sobre como conduzir a campanha, códigos e critérios a serem utilizados, orientações para a consolidação dos dados, estabelecimento de fluxos de referência, capacitação prática junto com o especialista na própria unidade de saúde a partir do reexame dos indivíduos que apresentavam alteração em tecidos moles e ampliação do número de serviços dirigidos ao diagnóstico bucal. Entre 2005 e 2009, houve redução significativa na taxa de casos confirmados de câncer bucal em cada 100 000 examinados, de 20,89 para 11,12 (P = 0,00003). CONCLUSÕES: A campanha trouxe benefícios à saúde bucal da população idosa. Pode ser ampliada para outros grupos etários e outras regiões do país e servir de subsídio para o desenvolvimento de ações de prevenção de câncer bucal em outros países, desde que respeitadas as características locais.

OBJECTIVE: To describe the strategies and results obtained by the early diagnosis and prevention of an oral cancer campaign targeting the population aged 60 years or older developed since 2001 in the state of São Paulo. METHODS: The main strategies used to develop the campaign were described based on the review of documents issued by the Health Ministry, National Cancer Institute, São Paulo State Health Department, Oncocentro Foundation of São Paulo, São Paulo City Health Department, School of Public Health at the University of São Paulo (USP), and Santa Marcelina Health Care Center. The impact of the campaign on the incidence of new cases of oral cancer in the target population was evaluated. RESULTS: In 2001, 90 886 elderly were examined vs. 629 613 in 2009. The following strategies were identified: training of professionals, development of printed materials to guide municipal governments in developing the campaign and using standardized codes and criteria, guidelines for data consolidation, establishment of patient referral flows, practical training with a specialist at the basic health care unit after the follow-up examination of individuals presenting changes in soft tissues, and increase in the number of oral diagnosis services. Between 2005 and 2009, there was a significant reduction in the rate of confirmed cases of oral cancer per 100 000 individuals examined, from 20.89 to 11.12 (P = 0.00003). CONCLUSIONS: The campaign was beneficial to the oral health of the elderly and could be extended to include other age groups and regions of the country. It may also provide a basis for the development of oral cancer prevention actions in other countries, as long as local characteristics are taken into account.

Tratamento Conservador de Osteorradionecrose de Mandíbula: Equidade e Racionalização de Recursos / Conservative Treatment of Mandibular Osteoradionecrosis: Equity and Rationalization of Resources

Relatar uma experiência de tratamento conservadore controle da ORN mandibular. Material e Métodos: Seis casosde ORN foram tratados com aplicação tópica diária desolução aquosa de gluconato de clorexidine à 0,12%, higienebucal rigorosa e eliminação de fatores irritantes à mucosa.As lesões orais de ORN tinham até 2cm no maior eixo. Oacompanhamento clínico foi realizado semanalmente até iníciode resposta ao tratamento e mensalmente após este período.A resposta à terapia foi classificada em: remissão total eparcial, aumento da lesão e ausência de resposta.Resultados: Dos seis pacientes, dois eram do sexo femininoe quatro do sexo masculino, com idades entre 39 a 78 anos.Todos os casos apresentaram resposta positiva tratamento,com três pacientes apresentando remissão parcial e trêscom remissão total. Após uma semana e meia, todos ospacientes relaram remissão total dos sinais prodrômicos daORN (dor e secreção purulenta). O tempo médio de tratamentofoi de 16,6 meses. Conclusão: Houve redução ou cura dosquadros clínicos dos casos acompanhados, e considera-seque esta evolução evitou o encaminhamento dos pacientespara câmara hiperbárica ou ainda a ressecção cirúrgica,deste modo, o tratamento relatado contribuiu para menormorbidade e racionalização de recursos do Sistema Únicode Saúde...

To report the results obtained in the conservativetreatment and control of mandibular ORN. Material andMethods: Six cases of ORN were treated with daily aqueoussolution of chlorhexidine gluconate 0.12% mouthwash,rigorous oral hygiene and removal of irritants to the mucosa.The oral lesions of ORN had up to 2 cm in greatest diameter.Clinical follow-up was conducted weekly until early responseto treatment and monthly, after that period. Response totherapy was classified as: total and partial remission,increased injury and absence of response. Results: Two ofthe six patients were female and four were male. Ages rangedfrom 39 to 78 years old. All cases showed some positiveresponse to the treatment, three patients had partial remissionand three patients had complete remission. In a week and ahalf, all patients presented total remission of ORN prodromalsigns (pain and purulent secretion). The average time oftreatment was 16.6 months. Conclusion: Reduction or totalheal of all ORN cases were achieved. It was noticeable thatthese results avoided indication of both hyperbaric oxygentherapy and surgical resection. Thus, thetreatment reported resulted in less morbidity to patients andrationalization of resources for the Public Health System...

Reorganization of secondary and tertiary health care levels: impact on the outcomes of oral cancer screening in the São Paulo State, Brazil

This study presents the strategies for prevention and early detection of oral cancer by means of screening in the elderly population of São Paulo, the richest and the most populous state of Brazil. This research was a retrospective longitudinal study based on the analysis of secondary data. The variables - number of participating cities, coverage of screening, and number of suspicious and confirmed cases of oral cancer - were divided into two periods: 2001-2004 and 2005-2008. Data were analyzed statistically by the chi-square test at 5% significance level. The implementation of a nationwide public oral health policy in 2004 and the reorganization of the secondary and tertiary health care were evaluated as mediator factors able to interfere in the achieved outcomes. From 2001 to 2008, 2,229,273 oral examinations were performed. There was an addition of 205 participating cities by the end of the studied period (p<0.0001). The coverage of oral cancer screening increased from 4.1% to 16% (p<0.0001). There was a decrease in the number of suspicious lesions (from 9% in 2005 to 5% in 2008) (p<0.0001) and in the rate of confirmed oral cancer cases per 100,000 examinations (from 20.89 in 2001 to 10.40 in 2008) (p<0.0001). After 8 years of screening, there was a decrease in the number of suspicious lesions and confirmed cases of oral cancer in the population. The reorganization of secondary and tertiary health care levels of oral care seems to have contributed to modify these numbers, having a positive impact on the outcomes of oral cancer screening in the São Paulo State.

Este estudo teve como objetivo apresentar as estratégias de prevenção e detecção precoce de câncer bucal, através de triagem (rastreamento) na população idosa do Estado de São Paulo. Esta pesquisa foi um estudo longitudinal retrospectivo baseado na análise de dados secundários. As variáveis -número de cidades participantes, a cobertura da triagem e o número de casos suspeitos e confirmados de câncer bucal - foram divididos em 2 períodos (2001-2004 e 2005-2008). As variáveis foram testadas através do teste do qui-quadrado. A implantação da política nacional de saúde bucal, em 2004, foi incluída como variável capaz de interferir nos resultados alcançados. De 2001 a 2008, 2.229.273 exames foram realizados. Foi observado um aumento de 205 cidades participantes até o final do período estudado (p<0,0001). A extensão do rastreamento para o câncer de boca aumentaram de 4,1% para 16% (p<0,0001). Houve uma diminuição no número de lesões suspeitas (de 9% em 2005 para 5% em 2008) (p<0,0001) e na taxa de casos confirmados de câncer bucal por 100.000 (20,89 em 2001 e 10,40 em 2008) (p=0,0003). Após 8 anos de triagem, observamos uma diminuição no número de lesões suspeitas e casos confirmados de câncer bucal entre os voluntários. É possível que a reorganização dos níveis secundário e terciário de cuidados bucais ajudou na modificação desses números.

Análise comparativa da proporção de óbitos segundo causas, de dentistas na cidade de São Paulo / Comparative analysis of cause-specific mortality for dentists in the city of São Paulo

Descreve-se a mortalidade proporcional de dentistas residentes na cidade de São Paulo, entre 1980 e 2000, segundo causas de óbito, em busca de possíveis indicações de risco atribuíveis ao trabalho, com dados levantados na Fundação Sistema Estadual de Análise de Dados. A análise comparativa usou informações análogas para médicos e engenheiros. O estudo dos diferenciais de óbito segundo causa básica indicou a ausência de alterações significantes, apontando risco potencial de óbito aumentado para dentistas em relação a médicos e engenheiros. Os óbitos de dentistas não apresentaram piores indicadores para categorias globais e específicas de doenças infecciosas, neoplasias, suicídio, doenças do sistema nervoso central e do aparelho circulatório. Foi observada indicação de excesso sistemático de óbitos de engenheiros por causas externas em geral, por acidentes de trânsito, quedas acidentais e demais acidentes em particular. Registrou-se a ausência de discrepâncias significantes que apontassem para risco diferencial atribuível ao trabalho de dentistas. Essa observação sugere que a Odontologia pode ser considerada uma profissão segura, ao menos no que diz respeito à exposição a riscos sistemáticos de óbito.