Exploration of the motivations in the adherence of patients to periodontal maintenance therapy / Exploración de las motivaciones en la adherencia de los pacientes en la mantención periodontal

Introduction: Although it has been shown that the supportive periodontal therapy (SPT) is essential to maintain the results obtained by periodontal therapy, patient adherence to SPT is not usually satisfactory (4). The objective of this research is to explore the motivations in the adherence to periodontal maintenance of patients treated at Universidad Viña del Mar (UVM) during the year 2020. Material and Methods: A study based on the qualitative paradigm was carried out using a design based on discourse analysis through semi-structured interviews. A sample size of 10 participants was consolidated, by obtaining with them the saturation of data collected and of 4 main dimensions. Each interview was transcribed ad verbatim and later analyzed through the Atlas.ti 9 Software. Results: Four main categories or dimensions were created: Motivations of the patients to produce a change in their oral health; Information that the patients have regarding their oral health; Oral hygiene habits acquired after periodontal treatment; Situations that prevent adherence to periodontal treatment. Conclusion: The main motivations of patients to adhere to supportive periodontal therapy are related to the education and information they acquire in the first phase of periodontal treatment. Observing the changes during treatment, improving oral health, improving aesthetics and functionality, are other important motivations, as well as the patients' fear of losing their teeth and the desire to educate their family.

Introducción: Aunque se ha demostrado que la fase de mantención periodontal (TPS) es esencial para mantener los resultados obtenidos por la terapia periodontal, la adherencia del paciente a la TPS no es, en su mayoría, satisfactoria (4). El objetivo de esta investigación es explorar las motivaciones de los pacientes en la adherencia a la mantención periodontal, atendidos en la Universidad Viña del Mar (UVM), durante el año 2020. Material y Métodos: Se realizó una investigación basada en el paradigma cualitativo por medio de un diseño en base al análisis de discursos a través de entrevistas semiestructuradas. Se consolidó un tamaño muestral de 10 participantes, al obtener con ellos la saturación de datos recolectados y de 4 dimensiones principales, cada entrevista fue transcrita ad verbatim y posteriormente analizadas a través del Software Atlas.ti 9. Resultados: Se generaron cuatro categorías o dimensiones principales: Motivaciones del paciente para generar un cambio en su salud oral, Información que posee el paciente respecto a su salud oral, Hábitos de higiene oral adquiridos posterior al tratamiento periodontal y Situaciones que impiden la adherencia al tratamiento periodontal. Conclusión: Las motivaciones principales que presentan los pacientes para adherirse a la fase de mantención periodontal, están relacionadas con la educación e información que adquieren en la primera fase del tratamiento periodontal. Observar los cambios durante el tratamiento, adquirir salud oral, mejorar la estética y funcionalidad, son otras motivaciones de importancia, así como el miedo que presenta el paciente de perder sus dientes y las ganas de querer educar a su familia.

Perda dentária e suas consequências psicossociais em adultos e idosos / Tooth loss and its psychosocial consequences in adults and older people / La pérdida de dientes y sus consecuencias psicosociales enadultos y ancianos

Introdução: É notório que a perda dentária é um obstáculo a ser lidado na saúde bucal, sendo ainda considerada um problema de saúde pública no Brasil que gera consequências físicas e psicológicas principalmente para adultos e idosos. Objetivo: Descrever as principais consequências psicossociais ocasionadas pela perda dentária em adultos e idosos. Metodologia: Trata-se de uma revisão integrativa da literatura, em que foram realizadas buscas bibliográficas eletrônicas com intervalo de tempo de publicação de seis anos (2016 -2022) nas bases de dados Biblioteca Virtual em Saúde (BVS) e Scientific Electronic Library Online (SciELO). Foram usados os descritores Perda de Dente, Saúde Bucal, Impacto Psicossocial, Adulto e Idoso com o auxílio do operador booleano "and", sendo contemplados artigos em português e inglês no qual o título, o resumo e a leitura na íntegra se relacionassem com o tema, e excluídas publicações do tipo monografias, dissertações, teses, capítulos de livros, livros na íntegra e artigos que não abordaram o tema de estudo. Resultados: Foram utilizados 14 artigos no total para compor o referencial teórico da revisão, sendo que todas essas publicações trouxeram informações relevantes quando se associa a perda dentária com o impacto psicossocial no público alvo. Situações como a vergonha ao sorrir ou falar em público e o comprometimento da fala geram um importante impacto na qualidade de vida dessas pessoas, despertando nelas um sentimento de inferioridade. Conclusão: A perda dentária abala a qualidade de vida das pessoas. Fatores psicológicos como a timidez, a vergonha e alteração de rotinas influenciam na vida social de adultos e idosos (AU).

Introduction:It is clear that tooth loss is an obstacle to be dealt with in oral health and it is still considered a public health problem in Brazil that brings physical and psychological consequences mainly for adults and older people.Objective:To describe the main psychosocial consequences caused by tooth loss in adults and older people.Methodology:This is an integrative literature review in which an electronic bibliographic search with a publication time interval of six years (2016 -2022) was performed in the Virtual Health Library (BVS) and Scientific Electronic Library Online databases (SciELO). The descriptors Tooth Loss, Oral Health, Psychosocial Impact, Adult and Elderly were used with interposition of the Boolean operator "AND". Articles in Portuguese and Englishwhose title, abstract and full text were related to the theme were selected. Publications such as undergraduate theses, master's dissertations, doctoral theses, book chapters, books, and articles that did not address the topic were excluded. Results: A total of 14 articles were used to compose the theoretical framework of the review and all brought relevant information as to the association between tooth loss and the psychosocial impact on the target audience.Situations such as embarrassment when smiling or speaking in public and speech impairment create animportantimpact on the quality of life of these people, awakening in them a feeling of inferiority. Conclusion:Tooth loss affects people's quality of life. Psychological factors such as shyness, shame, and change in routines influence the social life of adults and older people (AU).

Introducción: Es claro que la pérdida de dientes es un obstáculo a ser abordado en la saludbucal, y aún es considerado un problema de salud pública en Brasil que genera consecuencias físicas y psíquicas principalmente para adultos y ancianos.Objetivo: Describir las principales consecuencias psicosociales provocadas por la pérdida de dientes enadultos y ancianos.Metodología: Se trata de una revisión integradora de la literatura, en la que se realizaron búsquedas bibliográficas electrónicas con un intervalo de tiempo de publicación de seis años (2016 -2022) en las bases de datos Biblioteca Virtual en Salud (BVS) y Scientific Electronic Library Online (SciELO). Se utilizaron los descriptores Pérdida de Dientes, Salud Bucal, Impacto Psicosocial, Adulto y Anciano con la ayuda del operador booleano "y", con artículos en portugués e inglés en los que el título, resumen y lectura completa se relacionaron con el tema; fueron excluidas publicaciones como monografías, disertaciones, tesis, capítulos de libros, libros completos y artículos que no abordaron el tema de estudio.Resultados: Se utilizaron un total de 14 artículos para componer el marco teórico de la revisión, y todas estas publicaciones aportaron información relevante al asociar la pérdida de dientes con el impacto psicosocial en el público objetivo.Situaciones como la vergüenza al sonreír o hablar en público y el deterioro del habla generan un impactoimportanteen la calidad de vida de estas personas, despertando en ellos un sentimiento de inferioridad.Conclusión: La pérdida de dientes afecta la calidad de vida de las personas. Factores psicológicos como la timidez, la vergüenza y el cambio de rutinas influyen en la vida social de adultos y ancianos (AU).

Relationship between tooth loss, nutritional status and consumption of macro and micronutrients in elderly people from southern Brazil

Maintaining a functional natural dentition plays an important role in keeping a satisfactory nutritional status. The aim of this study was to evaluate the relationship between oral health conditions determined by the presence of edentulism and the number of missing teeth, nutritional status and consumption of nutrients by the elderly. This cross-sectional study comprised 494 independent elderly of both genders, over 60 years of age, registered at the Brazilian public health service in Londrina, southern Brazil. The data collection included: oral examinations; anthropometric measurements by calculating the Body Mass Index (BMI); analysis of food consumption based on a multiple pass 24-hour dietary recall and a food intake frequency questionnaire; and structured interviews to obtain sociodemographic information. Multiple linear regression, the Fisher's Exact test, chi-square and Mann-Whitney tests, were applied at a 5% significance level. The prevalence of edentulism was 47.3%; this predominated in females, age group from 65 to 74 years, low education level and low/medium economic classification. A larger numberof underweight and fewer number of overweight elderly were recorded among the edentulous versus dentate participants (< 0.0001). Significantly lower consumption of several nutrients, as well as fruit, was recorded among the edentulous group. In particular, carbohydrates, vitamins (B1, B9 and C), and the majority of the minerals studied were associated with a larger number of missing teeth. In conclusion, tooth loss was associated with the food consumption pattern of some macro-and micronutrients and the nutritional status of the Brazilian elderly.

Self-perception of oral health among tertiary-care users: quanti-qualitative analysis with chronic kidney disease patients

Chronic kidney disease (CKD) has become a global public health challenge. The objective of this study was to analyze the relationship between self-perception of oral health and clinical condition among patients with CKD. This isa quanti-qualitative survey conducted in a CKD specialized service. The sample consisted of 60 patients who underwent oral examinations to have their severity of caries (DMFT) and need for dental prosthesis checked. Age, sex, time on dialysis, marital status, skin color, education and pre-existing diseases were also analyzed. Among the kidney patients who agreed to undergo the clinical examinations and showed communication skills, some were selected, and three focus groups were created, with the participation of a moderator and six to 10 kidney patients in each group. Their speeches were processed in the IRAMUTEQ software and analyzed through the similarity analysis and word cloud techniques. As for profile, the patients were aged 60.23 ± 10.87 years old; were male (73.33%); were on dialysis for 41.90 ± 56.57 months; were married (61.67%); were white (76.67%); had incomplete primary education (41.66%); had arterial hypertension (76.67%); had a DMFT index of 22.55 ± 8.39; 43.33% needed an upper complete denture; and 30.00% needed a lower complete denture. The similarity analysis revealed many doubts and uncertainties about current health services, which can be proven by the words 'no' and 'treatment'. The quanti-qualitative analysis showed a high rate of dental loss and the need for complete dentures and suggests inequities in oral health care for chronic kidney disease patients, especially in tertiary care. There was a positive representation regarding oral health, but the lexicographical analyses of the textual corpusconfirmed the self-perception of lack of dental care.

Tooth Loss, Sociodemographic Conditions and Oral Health-Related Quality of Life in the Elderly

Abstract Objective: To verify the association between impacts produced by tooth loss and sociodemographic variables in the oral health-related quality of life (OHRQoL) in the elderly. Material and Methods: This is an analytical cross-sectional study carried out in the municipality of Vitória/ES, Brazil, which sample was composed of 402 older adults. The Oral Health Impact Profile (OHIP-14) was used to measure the individuals' OHRQoL. For data analysis, descriptive and bivariate analyses were performed using the Fisher's exact test and the Mantel-Haenzsel test to assess the effects of combined dimensions. The significance level adopted was 5%. To assess the strength of association between independent variables and dimensions, Odds-Ratio (OR) with 95% confidence interval (CI) was calculated. Results: The prevalence of negative impact on OHRQoL in the elderly was 32.6%. The greatest impact perception was found in individuals with up to 10 years of schooling (p=0.021 and OR=1.602), with need for removable partial dentures (p=0.000 and OR=2.873) and those who did not accept the loss of dental elements (p=0.000 and OR=3.064). Conclusion: Older female adults with socioeconomic class C/D-E, with up to 10 years of schooling, who lost 11 or more teeth, who declared the need for removable partial dentures, suffered greater impacts caused by tooth loss on OHRQoL.

Evaluating edentulism and frailty in a group of elderly people treated at the dental clinic of Universidad San Martín de Porres in Lambayeque, Peru / Condiciones de edentulismo y fragilidad en un grupo de personas mayores que acudieron a la clínica odontológica de la Universidad San Martín de Porres de Lambayeque, Perú

Introduction: Dentistry should contribute to achieving healthy aging based on the identification of the well-being and oral health needs of the elderly. Objective: To evaluate the conditions of edentulism and frailty in a group of elderly people treated at the dental clinic of Universidad San Martín de Porres in Lambayeque, Peru, between the years 2016 and 2018. Material and Methods: An observational, descriptive, retrolective, and cross-sectional study was conducted. Two hundred and seven medical records that included an odontogram were randomly selected to identify cases of total or partial edentulism according to the Kennedy classification. The files were assessed with Fried's test to evaluate the conditions of frailty. The association between variables was estimated by means of a significance analysis using the Chi square test. Results: There was a statistically significant difference between edentulism in both jaws and conditions of frailty (p<0.05). An association of edentulism with physical inactivity and weakness was also demonstrated. Additionally, a statistically significant difference between degrees of edentulism was observed regarding poor diet (p<0.05). Conclusion: The absence of teeth in the elderly acts as a risk factor leading to negative changes in diet, weight, and physical activity. These changes may be associated with frailty, as masticatory insufficiency results in a poor diet and subsequent weakness.

Introducción: El aporte de la Odontología debe contribuir a lograr un envejecimiento saludable, basado en la identificación de las necesidades de bienestar y salud bucal de las personas mayores. Objetivo: Evaluar la condición de edentulismo y de fragilidad en un grupo de personas mayores atendidas en la Clínica Odontológica de la Universidad San Martín de Porres de Lambayeque, entre los años 2016 y 2018. Material y Métodos: Se diseñó un estudio observacional, descriptivo, retrolectivo y transversal, seleccionando de manera aleatoria 207 historias clínicas que incluyeron un odontograma para identificar casos de edentulismo total o parcial de acuerdo a la clasificación de Kennedy: mientras que para evaluar las condiciones de fragilidad fueron revisadas las fichas con el test de Fried. Diferencias entre variables fueron evaluadas con un análisis de significancia mediante la prueba Chi cuadrado. Resultado: Se mostró una diferencia estadísticamente significativa entre edentulismo en ambos maxilares y condiciones de fragilidad (p<0,05). Se evidenció además asociación de edentulismo con inactividad física y debilidad; observándose adicionalmente una diferencia estadísticamente significativa entre grados de edentulismo en relación a la mala alimentación (p<0,05). Conclusion: La ausencia de dientes en las personas mayores funge como un factor de riesgo que contribuye a cambios desfavorables en la dieta, el peso y la actividad física, mismos que se asocian con la fragilidad, donde la insuficiencia masticatoria puede conducir a una deficiente alimentación y la consecuente debilidad.

The impacts of oral health-related quality of life of elderly people living at home: a cross-sectional study / Impactos da qualidade de vida relacionada à saúde bucal de idosos em domicílio: estudo transversal

Abstract The scope was to verify the impact of oral and sociodemographic conditions, the dental treatment needs and dental pain, on the quality of life of the elderly. This cross-sectional study was conducted in 15 primary health care areas. A backward multivariate linear regression model was used (p<0.05) with oral health related-quality of life as dependent variable. There were 335 elderly people with predominance of women (56.72%) and aged up to 74 years (59.40%). Those who had up to 8 years of education predominated (87.46%), and those who were still working were the minority (13.43%). Multivariate linear regression (p<0.05) showed association with missing teeth (β=0,12; IC 0,00:0,04; p<0,04) and dental prosthesis needs (β=0,14; IC 0,13:0,81; p<0,01), women (β=0,18; IC 0,23:0,85; p<0,01), less aged (β=-0,12; IC -0,05:0,00; p<0,02), not working (β=-0,15; IC -1,09:-0,20; p<0,01), with dental care need (β=0,24; IC 0,25:0,63; p<0,01) and dental pain (β=0,14; IC 0,10:0,64; p<0,01). Missing teeth, sociodemographic conditions, dental treatment needs and dental pain might impact oral health-related quality of life of elders.

Resumo O objetivo foi verificar o impacto da condição bucal e sociodemográfica, necessidade de tratamento odontológico e dor dentária na qualidade de vida de idosos. Este estudo transversal realizou-se em 15 áreas de cuidados primários de saúde. O modelo de regressão linear multivariado foi utilizado (p <0,05) considerando qualidade de vida como variável dependente. Participaram 335 idosos, predomínio de mulheres (56,72%) com idade até 74 anos (59,40%). Ter até 8 anos de estudo predominou (87,46%) e os que trabalhavam eram minoria (13,43%). A regressão linear multivariada (p <0,05) apresentou associação da qualidade de vida com dentes perdidos (β=0,12; IC 0,00:0,04; p<0,04) e necessidade de próteses (β =0,14; IC 0,13:0,81; p<0,01), com mulheres (β=0,18; IC 0,23:0,85; p<0,01), idosos mais jovens (β=-0,12; IC -0,05:0,00; p<0,02), que não trabalham (β=-0,15; IC -1,09:-0,20; p<0,01), com necessidades de tratamento odontológico (β=0,24; IC 0,25:0,63; p<0,01) e dor dentária (β=0,14; IC 0,10:0,64; p<0,01). Dentes perdidos, aspectos sociodemográficos, necessidade de tratamento odontológico e dor dentária podem impactar a qualidade de vida relacionada à saúde bucal de idosos.

The role of health literacy as a factor associated with tooth loss / O papel da literacia em saúde como fator associado às perdas dentárias

ABSTRACT OBJECTIVE The objective was to analyze the role of health literacy (HL) as a factor associated with tooth loss among users of the Brazilian Health System with chronic non-communicable diseases. METHODS The cross-sectional analytical study was conducted with adult and elderly users chosen at ten Family Health Clinics in a draw in the town of Piracicaba, São Paulo State, Brazil. A questionnaire was applied with sociodemographic data (sex, age, skin color and education), behavioral data (brushing and flossing), determinants in health (type of dental health services and how often) and clinical data (pain). Mouth conditions were collected by intraoral examination of visible dental biofilm and community Pediodontal Index. The systemic clinical conditions (blood glucose, glycated hemoglobin and blood pressure) were extracted from the medical records. The explanatory variable was HL (low, medium and high), measured with the Health Literacy Scale (HLS-14). RESULTS The outcome was tooth loss measured by the index of decayed, missing and filled teeth. Logistic regression was performed using a conceptual model for HL (p < 0.05). For the 238 subjects, the mean age was 62.7 years (± 10.55). Tooth loss was associated with HL in regression models adjusted by type of dental service, dental frequency, and dental floss. In the final model, the factors associated with tooth loss are older age (OR = 1,12; 95%CI: 1,07-1,17), a lower education (OR = 3,43; 95%CI: 1,17-10,10), irregular use of dental floss (OR = 4,58; 95%CI: 1.75 in-7,31), irregular use of dental services (n = 2,60; 95% 1,32-5,12), periodontal pocket (> 4 mm) (n = 0,31; 95%CI: 0,01-0,08), having visible dental biofilm (OR = 7,23; 95%CI: 3,19-16,41) and a higher level of blood sugar (glucose) (n = 1,98; 95%CI: 1.00-3,92). CONCLUSIONS tooth loss was associated with HL when adjusted by health behaviors; when sociodemographic variables and clinical conditions were included, it was less significant. In the final model, behaviors, determinants in health and clinical conditions were risk indicators of tooth loss, showing the multifactorial nature of this phenomenon.

RESUMO OBJETIVO O objetivo foi analisar o papel da Literacia em Saúde (LS) como fator associado às perdas dentárias entre usuários do Sistema Único de Saúde com doenças crônicas não transmissíveis. MÉTODOS O estudo transversal e analítico foi conduzido com usuários adultos e idosos selecionados em dez Unidades de Saúde da Família sorteadas, em Piracicaba - SP, Brasil. Foi aplicado um questionário com dados sociodemográficos (sexo, idade, cor da pele e escolaridade), comportamentais (escovação e uso de fio dental), determinantes em saúde (tipo e frequência de uso de serviço de saúde médico e odontológico) e clínica (dor). As condições bucais foram coletadas por exame intrabucal do biofilme dental visível e Índice Pediodontal Comunitário. As condições clínicas sistêmicas (glicemia, hemoglobina glicada e pressóricas) foram extraídas dos prontuários. A variável explanatória foi a LS (baixa, média e alta), medida pelo Health Literacy Scale (HLS-14). RESULTADOS O desfecho foi à perda dentária medida pelo Índice de dentes permanentes cariados, perdidos e obturados. Foi realizada regressão logística com uso de um modelo conceitual para a LS (p < 0,05). Para os 238 indivíduos, a média de idade foi 62,7 anos (± 10,55). A perda dentária esteve associada à LS nos modelos de regressão ajustados por tipo de serviço odontológico, frequência odontológica e uso de fio dental. No modelo final, a perda dentária teve como fatores associados a maior idade (OR = 1,12; IC95% 1,07-1,17), menor escolaridade (OR = 3,43; IC95% 1,17-10,10), ao uso irregular de fio dental (OR = 4,58; IC95% 1,75-7,31), uso irregular do serviço odontológico (OR = 2,60; IC95% 1,32-5,12), bolsa periodontal (> 4mm) (OR = 0,31; IC95% 0,01-0,08), ter biofilme dental visível (OR = 7,23; IC95% 3,19-16,41) e maior índice de glicemia (OR = 1,98; IC95% 1,00-3,92). CONCLUSÕES A perda dentária esteve associada à LS quando ajustada por comportamentos em saúde, a partir da inclusão das variáveis sociodemográficas e condições clínicas ela perdeu a significância. No modelo final, comportamentos, determinantes em saúde e condições clínicas foram indicadores de risco da perda dentária, demonstrando a multifatorialidade envolvida neste fenômeno.

Impact of oral conditions on the quality of life of elderly caregivers and oral health practices / O impacto das condições bucais na qualidade de vida de cuidadores domiciliares de idosos e práticas em saúde bucal

INTRODUCTION: Identifying factors related to the quality of life constitutes strategy for the actions supporting and monitoring the population health. OBJECTIVE: To assess oral health practices in the elderly, the clinical conditions of oral health of the caregiver and the elderly and oral health-related quality of life of caregiver. METHODS: Oral health was evaluated in 388 participants (194 caregivers and 194 elderly) by: the decayed, missing and filled teeth (DMFT) index, the use and need of prosthesis, the Oral Health Impact Profile (OHIP-14) scale and a semi-structured questionnaire. RESULTS: Most caregivers (91.3%) acquired oral health knowledge in daily practice, 33% performed oral hygiene in the elderly and 28% reported difficulties with this activity. The average DMFT was 19.24 for caregivers and 28.70 for the elderly, both with predominance of missing teeth. Prostheses were used by 57.73% of caregivers and 63.40% of elderly. The need of protheses was high, mostly in the mandible, respectively 34.54% and 51.55%. The association between OHIP-14 and the need for total prosthesis showed an impact on the dimensions physical and psychological disabilities. The importance of religion affected the dimension psychological discomfort and physical and psychological disabilities. Caregivers over 60 years old had a 1.2 greater chance of oral health impact on quality of life compared to the 20 to 60-year-old group. CONCLUSION: The presence of low-value cultural contexts of self-care associated with a positive perception of oral health, even in precarious clinical conditions, minimized the impact on caregivers' quality of life.

INTRODUÇÃO: Identificar fatores relacionados à qualidade de vida constitui estratégia para as ações de suporte e acompanhamento da saúde da população. OBJETIVO: Avaliar as práticas em saúde bucal nos idosos, as condições clínicas de saúde bucal do cuidador e do idoso e a qualidade de vida relacionada à saúde bucal dos cuidadores. MÉTODOS: A saúde bucal foi avaliada em 388 participantes (194 cuidadores e 194 idosos) usando: índice dentes cariados, perdidos e obturados (CPOD), uso e necessidade de próteses, instrumento Oral Health Impact Profile (OHIP-14) e questionário semiestruturado. RESULTADOS: A maioria dos cuidadores (91,3%) adquiriu conhecimento em saúde bucal na prática diária, 33% realizava higiene bucal no idoso e 28% relatou ter dificuldades com esta atividade. Registrou-se CPOD 19,24 para cuidadores e 28,70 para idosos, ambos com predomínio do compo­nente perdido. Dos cuidadores, 57,73% usava prótese e dos idosos, 63,40%. A necessidade das próteses foi alta principalmente na mandíbula, respectivamente 34,54% e 51,55%. A associação entre OHIP-14 e a necessidade de prótese total evidenciou impacto nas dimensões incapacidades física e psicológica. A importância da religião associou-se a impactos nas dimensões desconforto psicológico e incapacidades física e psicológica. Os cuidadores com 60 anos ou mais apresentaram chance de 1,2 vezes maior de impacto da saúde bucal na qualidade de vida quando comparados ao grupo de 20 a 60 anos. CONCLUSÃO: O impacto na qualidade de vida dos cuidadores foi minimizado pela presença de contextos culturais pouco valorativos de autocuidado associados à percepção positiva de saúde bucal, mesmo em condições clínicas precária.

Trastornos temporomandibulares e índice de dientes cariados, perdidos y obturados en personas con discapacidad psicosocial crónica internadas en el Hospital Psiquiátrico de la ciudad de Asunción, 2018 / Temporomandibular disorders and decayed, missing and filled teeth index in people with chronic psychosocial disability admitted to the Psychiatric Hospital of the city of Asunción, 2018

Introducción: Los pacientes con trastornos mentales están sometidos a un mayor número de factores de riesgo de enfermedades bucodentales y temporomandibulares. Ello debido a los efectos secundarios de las medicaciones que consumen, la falta de autocuidado, la dificultad para acceder a atención, la actitud hacia los profesionales sanitarios y también la falta de cooperación en los tratamientos dentales. Objetivo: Determinar la frecuencia de los trastornos temporomandibulares (TTM) y el índice de dientes cariados, perdidos y obturados (CPO-D) en pacientes con discapacidad psicosocial crónica internados en el Hospital Psiquiátrico de la ciudad de Asunción, Paraguay. Material y Métodos: El estudio tuvo un diseño observacional descriptivo de corte transversal y fue aprobado por el comité de ética institucional. Participaron 139 personas con discapacidad psicosocial crónica de ambos sexos, mayores de 18 años, en el mes de mayo, 2018. Como instrumentos de medición se utilizaron: un cuestionario de 3 preguntas, el examen clínico con 5 indicadores para la variable presencia de TTM, el odontograma para el índice CPO-D y los expedientes clínicos. Resultados: Se encontró una población en su mayoría masculina, con un rango de edad entre 40-50 años, y un alto porcentaje de fumadores activos. Se observó que el 83,5 % de los examinados presentaba TTM. El índice CPO-D fue 22,8. Entre los signos de TTM, el ruido articular fue el más común. Conclusión: Se observó una elevada frecuencia de TTM en las personas con discapacidad psicosocial y un elevado índice CPO-D. Palabras Claves: Salud bucal, trastornos ATM, índice CPO, salud mental, psiquiatría, trastorno psicosocial.

Introduction: Patients with mental disorders are subject to a greater number of risk factors for oral and temporomandibular diseases. This is due to the side effects of the medication they consume, the lack of self-care, the difficulty in accessing medical help, the attitude of the patients towards health professionals and also the lack of cooperation in their dental treatments. Objective: To determined the frequency of temporomandibular disorders (TMD) and the decayed, missing and filled teeth index (DMFT) in people with chronic psychosocial disability admitted to the Psychiatric Hospital of the city of Asunción. Material and Methods: This descriptive, observational and cross-sectional study was approved by the local ethics committee. One hundred and thirty-nine people with chronic psychosocial disabilities, of both sexes, over 18 years of age participated during May, 2018. The instruments used were a 3-item questionnaire, clinical examination with 5 indicators for presence of TMD, the odontogram for the DMFT index and the clinical charts. Results:A predominantly male population, with an age range between 40-50 years, and a high percentage of active smokers was found. TMD was found in 83.5% and the DMFT index was 22.8. Among the signs of TMD, joint noise was the most common. Conclusion:A high frequency of TMD was observed in people with psychosocial disabilities and a high CPO-D index. Key words: Oral health TMJ , disorder, DMF index, mental health, psychiatry

Edentulismo total em idosos: envelhecimento ou desigualdade social? / Total edentulism in older adults: aging or social inequality? / Edentulismo total en ancianos: ¿envejecimiento o desigualdad social?

Resumo Este estudo estimou a prevalência autorreferida de edentulismo total em idosos de 60 anos ou mais em município de Minas Gerais cadastrados na Estratégia Saúde da Família, identificando fatores socioeconômicos associados. Os dados foram coletados no domicílio dos participantes, aplicando-se questionário que abarcava aspectos sociodemográficos, econômicos e de saúde geral e bucal. A estatística utilizou a variável dependente "edentulismo total", com nível de significância de 5%. Participaram 1.750 idosos - 63,4% mulheres, 11,5% analfabetos e 27,8% com renda familiar abaixo do salário mínimo. O edentulismo total foi de 46,4%, com maior prevalência em mulheres, entrevistados com idade ≥80 anos, solteiros/viúvos/divorciados, analfabetos e idosos que não procuraram serviço odontológico nos últimos seis meses (p<0,05). A renda familiar foi menor para os edêntulos (p=0,001), e constatou-se alta prevalência dessa condição associada a fatores socioeconômicos, demonstrando iniquidade em saúde bucal e necessidade de proteção do Estado. Aprovação CEP-Unimontes 1.628.652

Abstract This study estimated the self-reported prevalence of total edentulism in older adults aged 60 years or older in a municipality of Minas Gerais, Brazil, enrolled in the Family Health Strategy and identified associated socioeconomic factors. Data collection took place in the participants' domiciles through a questionnaire including socio-demographic, economic, and general and oral health data. The statistical analysis used "total edentulism" as the dependent variable, with significance level of 5%. A total of 1,750 older adults participated, 63.4% of whom were female, 11.5% were illiterate and 27.8% had a family income below one minimum wage. Total edentulism was 46.4%, with a higher prevalence in women, in participants who were aged ≥80 years, single/widowed/divorced, illiterate and in those who did not seek dental service in the last six months (p<0.05). Family income was lower for the edentulous older adults (p=0.001), and a high prevalence was found for edentulism associated with socioeconomic factors, showing iniquity in oral health and, therefore, the need for State protection. Approval CEP-Unimontes 1.628.652

Resumen Este estudio estimó la prevalencia autorreferida de edentulismo total en ancianos de 60 años o más, registrados en la Estrategia de Salud Familiar, en el municipio de Minas Gerais, Brasil, e identificó factores socioeconómicos asociados. Los datos se recolectaron en el domicilio de los participantes, aplicándose un cuestionario que abarcaba aspectos sociodemográficos, económicos y de salud general y bucal. La estadística utilizó la variable dependiente "edentulismo total", con un nivel de significancia del 5%. Participaron 1.750 ancianos -el 63,4% mujeres, el 11,5% analfabetos y el 27,8% tenían renta familiar por debajo del salario mínimo. El edentulismo total fue del 46,4%, con mayor prevalencia en mujeres, encuestados con edad ≥80 años, solteros/viudos/divorciados, analfabetos y ancianos que no buscaron servicio odontológico en los últimos seis meses (p<0,05). La renta familiar fue más baja para los edéntulos (p=0,001), y se comprobó una alta prevalencia de esta condición asociada a factores socioeconómicos, demostrando la inequidad en la salud bucal y la necesidad de protección del Estado. Aprobación CEP-Unimontes 1.628.652

Uso e necessidade de prótese dentária em adultos e idosos em Minas Gerais: prevalência e fatores associados / Dental prosthesis need and use among adults and the elderly in Minas Gerais: prevalence and associated factors

Objetivo: Analisar fatores associados ao uso e à necessidade de prótese dentária em adultos e idosos do estado de Minas Gerais. Métodos: Estudo transversal foi realizado com amostra de 2.404 adultos e idosos. Regressão logística, estimativas de odds ratio e respectivos intervalos de confiança foram realizados. Resultados: Dos 2.404 indivíduos avaliados, 59,9% tinham necessidade de prótese pela ausência de prótese ou presença de prótese insatisfatória e 41,9% usavam prótese. Idosos tiveram 10,22 vezes mais chances de usar prótese comparados aos adultos. Indivíduos de menor escolaridade (< 2 anos de estudo) apresentaram 2,18 vezes mais chances de usar prótese do que indivíduos de maior escolaridade (> 11 anos de estudo). Indivíduos que usaram o serviço público na última consulta odontológica tiveram menos chance de usar prótese do que indivíduos que usaram o serviço privado. Conclusão:A necessidade e o uso de prótese dentária foram associados a fatores sociodemográficos.

Aim: To analyze factors associated with the need and use of dental prostheses in adults and the elderly in Minas Gerais, Brazil. Methods: This research conducted a cross-sectional study with 2,404 adult and elderly individuals. Logistic regression, odds ratio estimates, and respective confidence intervals were performed. Results:Among the 2,404 individuals evaluated in this study, 59.9% needed prosthesis due to a lack of a prosthesis or the use of an unsatisfactory prosthesis, while 41.9% used satisfactory prostheses. The elderly individuals were 10.22 times more likely to use prostheses w hen compared to adults. Individuals with a lower educational level (< 2 years of education) were 2.18 times more likely to use a prosthesis than were individuals with a higher educational level (> 11 years of education). Individuals who used the public dental services for their last dental appointment were less likely to use a prosthesis than were individuals who used private dental services. Conclusion: The need and use of dental prostheses were associated with sociodemographic factors.

Comparison of two oral health-related quality-of-life measures in elderly patients: the influence of missing teeth, and socio demographic factors / Comparação entre dois instrumentos de avaliação de qualidade de vida em pacientes idosos: a influência da perda de dentes e fatores sociodemográficos

Objective: The Oral Health Impact Profile-14 (OHIP14) and the Geriatric/General Oral Health Assessment Index (GOHAI) have never been compared to a group of the same subjects in the Brazilian population. The aim of the study was to compare the OHIP-14 and GOHAI measures. Material and Methods: 129 independently living people over the age of 60 were included in the study. The GOHAI and OHIP-14 measures were used. Other variables were included: age, gender, education, number of missing teeth, annual household income and frequency of dentist visits. Results: The mean age of respondents was 65 years. The internal reliability (Cronbach's alpha) showed a high internal consistency for both measures. Spearman's rank correlation coefficient between the GOHAI and OHIP-14 scores was 0.73. Using the additive method of creating scores, none of the respondents had the GOHAI score of zero, indicating no impact from oral conditions, while 9.3% of them had an OHIP-14 score of zero. Dental status, age, gendler and frequency of dental visit were significantly associated with the results ofthe GOHAI and the OHIP-14 (Kruskal­Wallis test, Mann­Whitney U test). Conclusions: There was a strong correlation between the GOHAI and the OHIP14. Both instruments demonstrated good discriminant properties and helped capture the respondents' oral health problems. (AU)

Objetivo: O Perfil de Impacto na Saúde Oral-14 (OHIP14) e o Índice Geral de Avaliação de Saúde Oral em Geriatria (GOHAI) nunca foram comparados a um grupo dos mesmos sujeitos na população brasileira. O objetivo do estudo foi comparar as medidas OHIP-14 e GOHAI. Material e Métodos: 129 pessoas independentes com idade superior a 60 anos foram incluídas no estudo. Foram utilizadas as medidas GOHAI e OHIP-14. Outras variáveis foram incluídas: idade, sexo, escolaridade, número de dentes ausentes, renda familiar anual e frequência de visitas ao dentista. Resultados: a média de idade dos entrevistados foi de 65 anos. A confiabilidade interna (alfa de Cronbach) mostrou uma alta consistência interna para ambas as medidas. O coeficiente de correlação de Spearman entre os escores GOHAI e OHIP-14 foi de 0,73. Utilizando o método aditivo de criação de escores, nenhum dos entrevistados obteve pontuação zero no GOHAI, indicando nenhum impacto das condições bucais, enquanto 9,3% deles tiveram pontuação zero no OHIP-14. O estado dentário, a idade, o sexo e a frequência da visita foram significativamente associados aos resultados do GOHAI e do OHIP-14 (teste de Kruskal-Wallis, teste de Mann-Whitney U). Conclusões: Houve uma forte correlação entre o GOHAI e o OHIP-14. Ambos os instrumentos demonstraram boas propriedades discriminantes e ajudaram a capturar os problemas de saúde bucal dos entrevistados. (AU)

Impact of seniors centers on oral health-related quality of life of older adults

ABSTRACT OBJECTIVE This study evaluated the oral health-related quality of life (OHRQoL) of older adults participating or not in Seniors Centers (SC). METHODS Two independent samples were compared: older adults who participate in SC (n = 124) and older adults who visited Primary Healthcare Centers (PHC) and do not participate in SC (n = 164). The data collected consisted of sociodemographic (sex, age, educational level, marital status, family income) and psychosocial characteristics—Sense of Coherence (SOC), anxiety and depression using HADS, happiness—, and oral clinical evaluation—use and need of dental prosthesis and decayed (D), missing (M), or filled (F) teeth. The resulting OHRQoL was evaluated using the Oral Health Impact Profile (OHIP-14). The Mann-Whitney test was used to assess the associations between the independent variables and the OHIP-14. Poisson regression models were also used in the analyses (α=0.05). RESULTS In the PHC, of the 270 individuals invited to participate in the study, 164 (60.7%) were interviewed and clinically examined; while in the SC, of the 166 individuals invited to participate in the study, 124 (74.7%) were interviewed and clinically examined. After adjustments for sociodemographic, psychosocial and clinical factors, we found that the impact on OHRQoL was 2.8 times higher (95%CI 2.0-4.2) for older adults who did not participate in SC. CONCLUSION Older adults who participated in SC showed better perception on OHRQoL, independently of sociodemographic, psychosocial and clinical factors.

Acúmulo de risco decorrente da pobreza e perda dentária aos 31 anos, coorte de nascidos vivos de 1982, Pelotas, Rio Grande do Sul, Brasil / Accumulated risk from poverty and tooth loss at 31 years of age: the 1982 live birth cohort in Pelotas, Rio Grande do Sul State, Brazil / Acumulación de riesgo derivado de la pobreza y pérdida dental a los 31 años: cohorte de nacidos vivos de 1982 en Pelotas, Rio Grande do Sul, Brasil

Resumo: O objetivo foi estimar o efeito do acúmulo de risco decorrente da pobreza na perda dentária aos 31 anos. Foram utilizados dados longitudinais da coorte de nascidos vivos de 1982, na cidade de Pelotas, Rio Grande do Sul, Brasil. Para a construção das variáveis de trajetória de renda, foram utilizados quatro pontos do tempo: nascimento, 15, 24 e 30 anos. Os fatores de confusão avaliados foram sexo, escolaridade materna, cor da pele da mãe e fumo aos 24 anos. Como potenciais mediadores, foram utilizados a trajetória de serviço odontológico e a cárie dentária baseada no Significant Index Caries (SIC). Para criação da variável de trajetória do modelo de acúmulo de risco, utilizou-se abordagem analítica de group-based trajectory modeling. O desfecho estudado foi o número de dentes perdidos aos 31 anos. A média de dentes perdidos aos 31 anos foi de 1,25 dente. No modelo de acúmulo de risco, após o ajuste para os confusores e mediadores, os indivíduos que estiveram pobres em um ou dois pontos do tempo apresentaram razão de risco - RR = 1,92 (IC95%: 1,40-2,63), e os que apresentaram três ou quatro episódios de pobreza apresentaram RR = 1,97 (IC95%: 1,24-3,13) para a perda dentária. Os resultados evidenciam o efeito do acúmulo de pobreza ao longo da vida na perda dentária. O efeito é ampliado entre os indivíduos que permaneceram mais tempo expostos à pobreza. As políticas públicas que visem a melhorar as condições de renda atuarão também na redução da perda dentária.

Abstract: The objective was to estimate the effect of accumulated risk from poverty and tooth loss at 31 years, using longitudinal data from the 1982 live birth cohort in Pelotas, Rio Grande do Sul State, Brazil. The income trajectory variables were built with four time points: birth and 15, 24, and 30 years of age. Potential confounding factors were sex, maternal schooling, maternal skin color, and smoking at 24 years. Potential mediators used the history of dentistry services use and caries based on the Significant Index Caries (SIC). The trajectory variable in the accumulated risk model was created with group-based trajectory modeling. The target outcome was the number of missing teeth at 31 years. Mean number of missing teeth at 31 years was 1.25. In the accumulated risk model after adjusting for confounders and mediators, individuals that were poor at one or two time points showed risk ratio - RR = 1.92 (95%CI: 1.40-2.63), and those with three or four episodes of poverty showed RR = 1.97 (95%CI: 1.24-3.13) for tooth loss. The results highlight the effect of lifetime poverty on tooth loss. The effect was expanded in individuals that were exposed to poverty longer. Public policies aimed at improving income conditions also help reduce tooth loss.

Resumen: El objetivo fue estimar el efecto de la acumulación de riesgo, derivado de la pobreza, en la pérdida dental a los 31 años. Se utilizaron datos longitudinales de la cohorte de nacidos vivos de 1982, en la ciudad de Pelotas, Rio Grande do Sul, Brasil. Para la construcción de las variables de trayectoria de renta se utilizaron cuatro puntos del tiempo: nacimiento, 15, 24 y 30 años. Los factores de confusión evaluados fueron: sexo, escolaridad materna, color de la piel de la madre y consumo de tabaco a los 24 años. Como potenciales mediadores se utilizó la trayectoria de servicios odontológicos y caries dental, basada en el Significant Index Caries (SIC). Para la creación de la variable de trayectoria del modelo de acumulación de riesgo se utilizó el abordaje analítico de group-based trajectory modeling. El resultado estudiado fue el número de dientes perdidos a los 31 años. La media de dientes perdidos a los 31 años fue 1,25 dientes. En el modelo de acumulación de riesgo, tras el ajuste para confusores y mediadores, los individuos que eran pobres en uno o dos puntos del tiempo presentaron razón de riesgo - RR = 1,92 (IC95%: 1,40-2,63) y quienes presentaron tres o cuatro episodios de pobreza presentaron RR = 1,97 (IC95%: 1,24-3,13) respecto a la pérdida dental. Los resultados evidencian el efecto de la acumulación de pobreza a lo largo de la vida en la pérdida dental. El efecto se amplía entre los individuos que permanecieron más tiempo expuestos a la pobreza. Las políticas públicas que tengan por objetivo mejorar las condiciones de renta actuarán también en la reducción de la pérdida dental.

Tooth loss and associated factors in the elderly in Cruz Alta, Brazil: a cross-sectional study / Perda dentária e fatores associados em idosos em Cruz Alta, Brazil: um estudo transversal

ABSTRACT The aim of this study was to evaluate severe tooth loss and associated factors among the elderly. A homebased crosssectional study, using random probabilistic sampling, was conducted with elderly persons from Cruz Alta, Rio Grande do Sul, Brazil. Oral health was examined and a structured questionnaire was answered. Associations between severe tooth loss and independent variables were determined using Poisson regression with robust variance. The level of significance adopted was 5%. Overall, 287 elderly persons were included. Among the elderly, 86 (29.9%) were edentulous, and 282 (98.3%) had lost at least one tooth. In this sample, median tooth loss was 21 (mean±standard deviation: 19.69±8.21). The sample was dichotomized into two groups according to the definition of severe tooth loss: less than nine remaining teeth or ≥9 remaining teeth. The prevalence of severe tooth loss was 60.3% (n=173). Females were associated with higher prevalence ratio (PR) of severe tooth loss (PR; 95% CI: 1.77; 1.39 - 2.24). Higher level of education was associated with lower PR of severe tooth loss (PR; 95% CI: 0.48; 0.30 - 0.77). The lack of access to dental care was associated with severe tooth loss (PR; 95% CI: 1.38; 1.13 - 1.67). Conversely, frequency of toothbrushing was not significantly associated with severe tooth loss (PR; 95% CI: 0.88; 0.73 - 1.06). High prevalence of severe tooth loss among the elderly was observed and found to be associated with sex, level of education, and access to dental care.

RESUMO Esse estudo objetivou avaliar a perda dentária severa e seus fatores associadas em idosos. Um estudo transversal, de base populacional, usando uma amostra probabilística, foi condu zido com os idosos de Cruz Alta, Rio Grande do Sul, Brasil. Exames de saúde bucal e um questionário estruturado foram realizados. Associações entre perda dentária severa e as variáveis independentes foram feitas, utilizando regressão de Poisson com variância robusta. O nível de significância adotado foi de 5%. No total, 287 idosos foram incluídos. Entre os idosos, 86 (29,9%) eram edêntulos, e 282 (98,3%) apresen tavam pelo menos uma perda dentária. Nessa amostra, a mediana de perda dentária foi 21 (média ± desvio padrão: 19,69±8,21). A amostra foi dividida em dois grupos de acordo com a definição de perda dentária severa: menos de nove dentes remanescentes ou ≥9 dentes presentes. A prevalência de perda dentária severa foi de 60,3% (n=173). As mulheres estiveram associadas com maior razão de prevalência (RP) de terem perda dentária severa (RP; IC95%: 1,77; 1,39 - 2,24). Alto nível educacional esteve associados com menor RP de ter perda dentária severa (RP; IC95% 0,48; 0,30 -0,77). A falta de acesso ao dentista esteve associada com maiores taxas de perda de dentária severa (RP; IC95%: 1,38; 1,13 -1,67). Por outro lado, frequência de escovação não esteve significati vamente associada perda dentária severa (RP; IC95%: 0,88; 0,73 - 1,06). Alta prevalência de perda dentária severa foi detectada entre os idosos e ela foi associada com sexo, nível educacional, e acesso ao dentista.

Perda do primeiro molar permanente e necessidade de tratamento endodôntico aos 12 anos no Brasil / Permanent first molar loss and need for endodontic treatment at age 12 in Brazil / Pérdida del primer molar permanente y necesidad de tratamiento endodóntico a los 12 años en Brazil

Objetivo: Objetivou-se discutir as desigualdades regionais e de renda na perda do primeiro molar permanente e necessidade de tratamento endodôntico aos 12 anos, Brasil. Foram analisados dados de 7328 crianças de 12 anos, examinadas no levantamento epidemiológico em saúde bucal de base nacional SB Brasil 2010. Métodos: A associação entre as variáveis dependentes e variáveis relativas às dimensões geográficas brasileiras e renda foi realizada pelo teste de associação qui-quadrado, nível de significância de 5%, estimando-se a razão de prevalência. Resultados: No Norte, há cinco vezes mais perda de molares em relação ao Sul e Sudeste, e no Nordeste, 2,6 vezes em relação ao Sudeste. As variáveis associadas à perda de primeiro molar e à necessidade de tratamento endodôntico foram, respectivamente, menor renda familiar (RP=3,07; 95%IC: 1,33-7,11), (RP=3,24; 95% IC: 1,64-6,41), e morar no interior das Regiões Norte, Nordeste e Centro-Oeste. Conclusão: Este estudo revela desigualdade na forma de tratamento da cárie no Brasil, com tratamento mutilador mais frequente no Norte, Nordeste, interior do Centro-Oeste e em famílias com menor renda, similarmente à necessidade de tratamento endodôntico, que indica presença de cárie em seu nível mais grave, representando ausência de tratamento precoce e dificuldade de acesso aos serviços de saúde. (AU)

Objectives: Aimed to analyses the regional and income inequalities in the loss of the first permanent molar and the need for endodontic treatment in children of 12 years, Brazil. Database of 7328 children aged 12 years examined in nationwide oral health epidemiological survey SB Brazil 2010 were analyzed. Methods: The association between the diagnosed cases and variables related of Brazilian geographic dimensions and income was performed using the chi-square testat a 5% significance level, estimating the prevalence ratio. Results: In North there are about fivetimes moreloss ofmolarsin relation to the Southand Southeastand Northeast 2.6 times the Southeast. Variables associated with loss of the first molar and the need for endodontic treatment were lower family income (PR=3,07; 95% IC: 1,33-7,11), (PR=3,24; 95% IC: 1,64-6,41) and live in the countryside of North, Northeast and Midwest. Conclusion: This study reveals inequality in carie treatment way sin Brazil, where the mutilating treatmentis more commonin North,Northeast, inside theMidwest andin families with lower income, similar to the need for endodontic treatment, which indicates the presence of caries in its mosts everelevel, representing the absence of early treatment for these individual sandlack of access to health services. (AU)

Objetivo: El objetivo fue discutir los ingresos y las desigualdades regionales en la pérdida del primer molar permanente y la necesidad de tratamiento endodóntico a los 12 años, Brasil. Se analizaron datos de 7328 niños de 12 años analizados en la encuesta epidemiológica nacional de salud bucal SB Brasil 2010. Métodos: La asociación entre variables dependientes y variables relacionadas con las dimensiones geográficas e ingresos brasileños se realizó mediante la prueba de asociación de chi-cuadrado, nivel de significación del 5%, estimando la razón de prevalencia. Resultados: en el Norte, hay cinco veces más pérdida molar en relación con el Sur y el Sudeste, y en el Noreste, 2.6 veces en relación con el Sudeste. Las variables asociadas con la pérdida del primer molar y la necesidad de tratamiento endodóntico fueron, respectivamente, un menor ingreso familiar (RP = 3.07; IC 95%: 1.33-7.11), (RP = 3.24; 95% IC: 1.64-6.41), y vivir en interior del Norte, Nordeste y Medio Oeste. Conclusión: Este estudio revela desigualdad en el tratamiento de la caries en Brasil, con un tratamiento mutilante más frecuente en el Norte, Nordeste, interior del Centro-Oeste y en familias de bajos ingresos, similar a la necesidad de tratamiento endodóntico, lo que indica la presencia de caries en nivel severo, que representa la falta de tratamiento temprano y la dificultad para acceder a los servicios de salud. (AU)

Experiências de perda dentária em usuários adultos e idosos da Atenção Primária à Saúde / Tooth loss experiences in adult and elderly users of Primary Health Care

Resumo Partindo da perspectiva teórica da fenomenologia, este artigo propôs-se a compreender as experiências de perda dentária em usuários da Atenção Primária à Saúde de Porto Alegre, Rio Grande do Sul. A perda dentária foi identificada pela análise de prontuários odontológicos dos usuários adultos e idosos que acessaram o serviço de saúde bucal na Unidade de Saúde estudada. A partir desta identificação, entrevistas domiciliares individuais foram realizadas. A amostra foi intencional. Os dados foram interpretados pela análise de conteúdo, com apoio do software ATLAS.ti (Visual Qualitative Data Analysis). O estudo teve aprovação ética. Perder dentes foi uma experiência que expressou subjetividades, mostrando narrativas plurais, com destaque para a função social da boca. Para além do número de dentes perdidos, o entendimento do modo como as pessoas se percebiam sem esses dentes determinou o quanto a perda dentária afetou suas vidas. O uso de próteses agregou valor ao corpo, permitindo o restabelecimento do seu equilíbrio com o mundo. Estudos de abordagem qualitativa nos serviços de saúde devem ser considerados para o planejamento de ações que priorizem as necessidades percebidas pelas pessoas em seus territórios, buscando reduzir estigmas e desigualdades sociais.

Abstract From the theoretical perspective of phenomenology, this article seeks to understand the experiences of tooth loss in adult and elderly users of Primary Health Care in Porto Alegre, Rio Grande do Sul. Tooth loss was identified by the analysis of dental records of users that attended the oral health service at the Health Unit under study. Following this identification, individual household interviews were carried out. The sample was intentional. Data were interpreted by content analysis using the software ATLAS.ti (Visual Qualitative Data Analysis). The study had ethical approval. Losing teeth was an experience that expresses subjectivities, showing plural narratives and highlighting the social function of the mouth. Besides the number of missing teeth, the understanding of how people perceived themselves without their teeth determined how much tooth loss affected their lives. Wearing prostheses adds significance to individuals' perceptions of their body, restoring the balance between their body and the world. Qualitative approach studies in health services should be considered in order to plan interventions which prioritize people's individual needs in their own territories, thus reducing stigmas and social inequalities.

A Saúde bucal está associada à presença de sintomas depressivos em idosos? / Is oral health associated with the presence of depressive symptoms among the elderly?

Resumo O objetivo do estudo foi descrever a prevalência de sintomas depressivos medidos por meio da Escala de Depressão Geriátrica-EDG - 15 e testar a associação de variáveis de saúde bucal com sintomas depressivos em uma população de idosos vinculados a onze unidades de saúde da família do Sul do Brasil. Estudo transversal com 439 idosos. Foi utilizado questionário padronizado para a obtenção das variáveis socioeconômicas e de saúde bucal. As variáveis clínicas de saúde bucal foram obtidas por um dentista treinado. Os sintomas depressivos desfecho do estudo foram obtidos por meio da Escala de Depressão Geriátrica-EDG - 15. A prevalência dos sintomas depressivos foi de 18,3% (IC95% 14,6-21,8). Analisando as variáveis de exposição e os sintomas depressivos, por meio da análise regressão de Poisson ajustada, os indivíduos com 1 a 9 dentes (RP = 1,68; IC95%1,06-2,64, p = 0,012), com percepção de boca seca (RP = 2,23; IC95%1,52-3,28, p < 0,001) e de dor na boca (RP = 2,11; IC95% 1,10-4,07, p = 0,036) tiveram maiores prevalências de sintomas depressivos. O estudo identificou uma prevalência importante de sintomas depressivos e que as variáveis de saúde bucal estão associadas à presença dos mesmos na população idosa.

Abstract The scope of this study was to describe the prevalence of depressive symptoms measured by the Geriatric Depression Scale-EDG - 15 and test the association of oral health variables and depressive symptoms in a population of the elderly linked to eleven Family Health Units in the south of Brazil. It involved a cross-sectional study with 439 elderly individuals. A standardized questionnaire was used to obtain socio-economic and oral health variables of the study. The clinical variables of oral health were obtained by a qualified dentist. The symptoms of depression, which was the scope of the study, were obtained by the Geriatric Depression Scale-EDG −15. The prevalence of depressive symptoms was 18.3% (CI95% 14.6-21.8). Analyzing the exposure variables and depressive symptoms through adjusted Poisson regression analysis, individuals with 1 to 9 teeth (PR = 1.68; CI95% 1.06-2.64, p = 0.012), with a perception of dry mouth (PR = 2.23; CI95% 1.52-3.28, p < 0.001) and perception of pain in the mouth (PR = 2.11; CI95% 1.10-4.07, p = 0.036) have a higher prevalence of depressive symptoms. The study identified a significant prevalence of depressive symptoms and that oral health variables are associated with the presence of depressive symptoms in the elderly population.

Lack of association between dietary inflammatory index and low impact fractures in the Brazilian population: the Brazilian Osteoporosis Study (BRAZOS)

Abstract Introduction: Adequate nutrition, including intake of dietary calcium and vitamin D, is important to maintain bone health. Evidence suggests that a deficiency in micronutrients may contribute to bone loss during aging and exert generalized effects on chronic inflammation. Recently, the Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of individual diets. Our aim was to evaluate the DII in a representative sample and verify its association with low-impact fractures. Methods: Individuals from The Brazilian Osteoporosis Study (BRAZOS) database had their DII calculated. BRAZOS is an important cross-sectional epidemiological study carried out with a representative sample of men and women ≥40 years old. The research was conducted through in-home interviews administered by a trained team. Nutrition Database System for Research (NDSR) software was used to analyze data on the intake of nutrients, which were employed to calculate the DII using Statistical Analysis Software (SAS®) and Statistical Package for the Social Sciences (SPSS®) to assess its association with low-impact fractures. Results: A total of 2269 subjects had their DII score calculated using information from 24-h recall data. Males had lower DII than females (DII = 1.12 ± 1.04 vs DII = 1.24 ± 0.99, p = 0.012). Women taking statins had lower DII (DII = 0.65 ±1.14 vs DII + 1.26 ± 0.98, p = 0.002), indicating a greater potential for diet-related anti-inflammatory effects. Conclusion: Our findings suggest that women might have a pro-inflammatory diet pattern compared to men. However, we did not find any association between DII scores and low-impact fractures.