[Primary dental healthcare in Brazil: the work process of oral health teams]

Adequação dos serviços odontológicos do Paraná no enfrentamento da Covid-19: um estudo transversal

RESUMO O objetivo deste estudo transversal foi identificar adequações quanto à utilização de Equipamentos de Proteção Individual e organização do processo de trabalho no atendimento odontológico ambulatorial no Paraná durante o primeiro ano da pandemia da Covid-19. A amostra de conveniência incluiu 1.105 profissionais de saúde bucal (cirurgiões-dentistas, técnicos e auxiliares em saúde bucal) durante o primeiro ano da pandemia (agosto a outubro de 2020). Formulário on-line (Google Formulários®) foi enviado por e-mail pelo Conselho Regional de Odontologia. As medidas de enfrentamento da Covid-19 foram comparadas entre os tipos de serviços odontológicos: ambulatorial do Sistema Único de Saúde – SUS (Atenção Primária, Centro de Especialidades Odontológicos e Pronto Atendimento), clínica privada, e outros (Sistema S, forças de segurança, sindicatos, hospitais públicos e privados e clínicas de ensino). Os profissionais dos serviços ambulatoriais do SUS relataram com maior frequência que: suspenderam atendimentos eletivos, evitavam gerar aerossóis e trabalhavam a quatro mãos. Nas clínicas privadas, utilizavam frequentemente teleorientação e telemonitoramento. Nos ‘outros serviços’, houve maior proporção de redução das horas de trabalho e autoclavagem de peças de mão após cada atendimento. Conclui-se que, apesar da alta adequação às medidas de enfrentamento da Covid-19, houve diferença na prática profissional nos diferentes tipos de serviços odontológicos.

Characteristics and in-hospital morbidity trends associated with oral and oropharyngeal cancers in Brazil

Background

Brazil experienced an expansion of the population's access to oral health policies after the creation of the Unified Health System (SUS, Sistema Único de Saúde). Through public policies, the consolidation of Primary Health Care (PHC) and the incorporation of dental care into primary and hospital care took place. The objective of this study was to identify epidemiological aspects, including the temporal trend, of hospital morbidity from oral and oropharyngeal cancer in Brazil, considering hospitalizations for this neoplasm in a hospital network linked to the public care system.

Methods

Observational study based on information on hospital admissions for oral cancer throughout Brazil. The research used data from the Brazilian Cancer Registry Information System. For the temporal series analysis, generalized linear regression model was used with the Prais-Winsten method.

Results

Of the 121,971 patients hospitalized with oral and oropharyngeal cancers, 76.40% were male and 23.60% were female, resulting in a M:F ratio of 3.24:1. Regarding the anatomical region of involvement among hospitalized patients with oral cavity neoplastic lesions, there was a predominance in non-specific places in the mouth, such as the floor of the mouth, soft and hard palate, among others (32.68%), followed by lesions in the region of tongue (28.89%). In this population, the predominant age group was between the fifth decade (31.09%) and sixth decade of life (24.99%); men presented neoplastic lesions of oral and oropharyngeal cancers at an earlier age than women. In all regions of the country, the staging of cases diagnosed in the tertiary health network accredited to the José Alencar Gomes da Silva National Cancer Institute (INCA) was late, with higher tendency for metastasis. The temporal trend of the adjusted in-hospital morbidity rates showed to be increasing in the Northeast, South and Midwest regions for the male gender. For females, they were increasing in the Northeast and South regions.

Conclusions

It is concluded that the distribution of in-hospital morbidity rates of oral and oropharyngeal cancers in the country is irregular. There is a greater number of cases identified by the study in male patients and in the Southeast and South regions; with an increasing tendency of this coefficient in both genders.

Inequalities in the profile of using dental services in Brazil

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.

Socioeconomic and Demographic Contexts of Brazilian and International University Students Regarding the Use of Dental Services

This article characterizes the different socioeconomic and demographic contexts regarding the use and access to dental services by Brazilian and African students at a Brazilian university of international nature. This is a cross-sectional, analytical, observational study with a quantitative approach, with data produced by 350 students from a public university in the state of Ceará. Sociodemographic and economic factors, participation in educational activities, self-perception of oral health, and use of dental services by academics were analyzed. The results obtained indicated that of the university students participating in the study, 74.0% had already used dental services, of which 57.43% were Brazilian and 42.57% international. There was a significant association between being a Brazilian academic and having already used dental services, having an income less than or equal to the minimum wage, and having used the public dental service. The determination of the prevalence of use of dental services and the different contexts of university students can assist in planning future actions in oral health that prioritize groups of university students with greater difficulties in the use and access of these services.

Série temporal da produção odontológica no Sistema Único de Saúde, Brasil, 2008-2018

Resumo Objetivo: Analisar a realização de procedimentos odontológicos pelo Sistema Único de Saúde (SUS), no Brasil e suas regiões geopolíticas, entre 2008 e 2018. Métodos: Estudo de série temporal, com dados do Sistema de Informações Ambulatoriais dos SUS. Foram calculadas taxas anuais de procedimentos odontológicos (por 100 mil habitantes), globais e por categorias de procedimentos e regiões. Utilizou-se a regressão de Prais-Winsten para analisar as tendências temporais e foram calculadas variações percentuais anuais (VPA). Resultados: Tendências decrescentes foram encontradas para o Brasil, em ações coletivas (VPA= -13,5%; IC95% -21,1;-5,2), ações preventivas individuais (VPA= -6,2%; - IC95% -7,7;-4,8), restaurações (VPA= -7,3%; IC95% -10,5;-3,9) e exodontias (VPA= -6,9; IC95% -10,5;-3,1). Endodontia e periodontia apresentaram tendências estacionárias para a maioria das regiões e o Brasil. Procedimentos protéticos apresentaram tendência ascendente em todas as regiões e no Brasil (VPA= 16,9%; IC95% 9,1;25,2). Conclusão: A produção odontológica no SUS apresentou decréscimo no período 2008-2018; à exceção de procedimentos protéticos, cuja produção aumentou.

[Contextual and individual factors associated with dissatisfaction with dental care in Brazil]

The scope of this study was to evaluate the influence of contextual and individual factors associated with dissatisfaction of users of the Unified Health System (SUS) with the care provided by dentists in Primary Health Care. It is a cross-sectional and multilevel study, based on secondary data derived from a national basic research project to assess user satisfaction with the SUS. Data were collected by the Ombudsman's Department of the SUS by telephone contact with a sample of 35,393 individuals from around the country. Contextual and individual variables were associated with dissatisfaction with the dental service provided by the SUS. For the analysis, Stata version 11.0 software was used together with multilevel random effects logistic regression. A total of 2,331 individuals from 61 municipalities were included in the final sample of satisfaction with the dental service. Only 43% of the participants reported that their claims had been resolved, and a seven times greater chance of dissatisfaction was perceived for those individuals who had unresolved demand in relation to those who resolved it. This research provides input that can subsidize the government in actions aimed at improving access and quality of care provided in dental care.

Progress and challenges in potential access to oral health primary care services in Brazil: A population-based panel study with latent transition analysis

OBJECTIVE

Compared indicators of potential access to oral health services sought in two cycles of the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB), verifying whether the program generated changes in access to oral health services.

METHODS

Transitional analysis of latent classes was used to analyze two cross-sections of the external evaluation of the PMAQ-AB (Cycle I: 2011-2012 and Cycle II: 2013-2014), identifying completeness classes for a structure and work process related to oral health. Consider three indicators of structure (presence of a dental surgeon, existence of a dental office and operating at minimum hours) and five of the work process (scheduling every day of the week, home visits, basic dental procedures, scheduling for spontaneous demand and continuation of treatment). Choropleth maps and hotspots were made.

RESULTS

The proportion of elements that had one or more dentist (CD), dental office and operated at minimum hours varied from 65.56% to 67.13 between the two cycles of the PMAQ-AB. The number of teams that made appointments every day of the week increased 8.7% and those that made home visits varied from 44.51% to 52.88%. The reduction in the number of teams that reported guaranteeing the agenda for accommodating spontaneous demand, varying from 62.41% to 60.11% and in the continuity of treatment, varying from 63.41% to 61.11%. For the structure of health requirements, the predominant completeness profile was "Best completeness" in both cycles, comprising 71.0% of the sets at time 1 and 67.0% at time 2. The proportion of teams with "Best completeness" increased by 89.1%, the one with "Worst completeness" increased by 20%, while those with "Average completeness" decreased by 66.3%.

CONCLUSION

We identified positive changes in the indicators of potential access to oral health services, expanding the users' ability to use them. However, some access attributes remain unsatisfactory, with organizational barriers persisting.

Oral health work process: disparity between teams in Brazil, 2014

OBJECTIVE

To compare Modality I and Modality II Oral Health Teams (OHT) regarding work process performance and differences between Brazilian regions.

METHODS

This was a cross-sectional study with OHTs that took part in the National Program for Primary Health Care Access and Quality Improvement (2013-2014). Latent Class Analysis identified OHT subgroups according to work process (action planning, health promotion actions and comprehensive health care) performance (consolidated, developing or incipient). OHT modalities were compared, resulting in an Index of Disparity.

RESULTS

After evaluating 15,886 OHTs, Modality II OHTs were found to have a higher percentage of consolidated work processes in the Southeast (67.8%-94.6%) and Southern (54.8%-93.0%) regions. Disparity in the consolidated work process was greater among Modality II OHTs (6.3-26.5) compared to Modality I OHTs (3.9-18.4).

CONCLUSION

Modality II OHTs have the potential for better performance regarding the work process, but with regional disparities.

Condições de Saúde bucal e acuidade visual dos estudantes em um município do Baixo Amazonas

Resumo Objetivo Avaliar a prevalência da cárie dentária e da deficiência visual nos escolares do ensino fundamental da rede pública de ensino de Barreirinha-AM e verificar os fatores associados a estas condições. Método Estudo transversal, com 1.828 estudantes entre 06 e 17 anos, da rede pública de ensino, Barreirinha. A avaliação da cárie dentária seguiu as recomendações da Organização Mundial da Saúde utilizando os critérios estabelecidos para as condições dentárias, tanto para dentes decíduos, quanto para permanentes: cariados, perdidos e obturados. O índice Significant Caries Index mediu a severidade da cárie dentária nos indivíduos mais afetados com a doença. Realizou-se avaliação para acuidade visual e analisou-se idade, sexo e escola. Resultados Evidenciou-se elevada prevalência de cárie dentária, desigualdade em sua distribuição e associação entre esta doença e sexo (p = 0,005). A prevalência de dificuldades visuais entre os escolares foi baixa. Conclusão e implicações para prática O estudo sugere carência de tratamento odontológico restaurador e elevada prevalência de cárie dentária, evidenciando a necessidade de planejamento e desenvolvimento de ações de promoção de saúde bucal, com o intuito de minimizar os agravos provocados pela doença.

Estrutura dos serviços de saúde bucal ofertados na Atenção Básica no Brasil: diferenças regionais

RESUMO Teve-se por objetivo analisar as condições de acessibilidade, estrutura e oferta de serviços odontológicos de Unidades Básicas de Saúde com Equipe de Saúde Bucal e compará-los entre as regiões geográficas brasileiras. O estudo quantitativo, analítico e transversal utilizou dados secundários referentes aos Módulo I, V e VI da Avaliação Externa do 2º Ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) (2013-2014). A análise descritiva foi realizada por frequências absolutas (n) e relativas (%), e houve comparação entre regiões brasileiras pelo teste qui-quadrado com uso do Teste Z ajustado pelo método Bonferroni (p<0,05). A amostra foi constituída por 24.056 Unidades Básicas de Saúde, nas quais atuavam 29.778 Equipes de Atenção Básica; destas, 16.203 (67,3%) possuíam serviços odontológicos e abrigavam 18.119 Equipes de Saúde Bucal. De maneira geral, as Unidades Básicas de Saúde apresentavam boa estrutura física, porém, baixa acessibilidade para pessoas com deficiência. Os consultórios odontológicos apresentavam estrutura física adequada e equipamentos, instrumentos e insumos odontológicos suficientes. No entanto, exibiam alta proporção na oferta de serviço mutiladores em comparação a procedimentos que evitariam as extrações dentárias, e baixa oferta de referência especializada. Além disso, houve evidenciadas desigualdades regionais, favoráveis às regiões Sul e Sudeste.

Fatores associados à satisfação dos usuários com a atenção à saúde bucal na Paraíba, 2014

RESUMO Objetivou-se identificar os fatores associados à satisfação dos usuários com a oferta de cuidado em saúde bucal na Paraíba a partir de dados do 2º ciclo de avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). As respostas dos usuários que passaram por consulta odontológica com a Equipe de Saúde Bucal (ESB) e possuíam dados completos foram analisadas por meio de regressão logística. Em relação à variável dependente ‘Satisfação do usuário’, 87% dos usuários (n=2.047), afirmaram estar satisfeitos com o cuidado que recebem da ESB. A insatisfação foi influenciada pelo fato de o usuário nunca ou quase nunca ser orientado sobre os cuidados com a sua saúde bucal (OR=4,27); o tempo da consulta ser insuficiente (OR=3,38); os profissionais não fazerem anotações no prontuário ou ficha (OR=1,97); a ESB não atender no turno da tarde (OR=1,66); o horário do atendimento odontológico não satisfazer às necessidades dos usuários (OR=2,86); e a ESB não procurar o usuário quando este interrompe o tratamento ou não comparece à consulta odontológica para saber o que aconteceu e retomar o atendimento (OR=1,59). Conclui-se ser expressivo o percentual de usuários satisfeitos com a atenção em saúde bucal na Paraíba, estando os fatores que influenciam a satisfação relacionados principalmente ao atendimento das necessidades dos usuários e ao processo de trabalho da ESB.

Performance of the oral health team in home care in the context of the Family Health Strategy: an integrative review

This is an integrative review that aimed to analyze the performance of the oral health team in home care within the Family Health Strategy, after the publication of the National Oral Health Policy Guidelines. Databases PubMed, Lilacs and SciELO were used in the 2004-2018 period. The selected papers (n=17) were organized in Excel sheet with data: author, year of publication, title, objectives, publishing journal, study location, type of study and thematic category. Two categories emerged from the thematic analysis: "Oral health practices in the household context and the work process of the oral health team" (n=11) and "Instruments for the management and evaluation of home care by the oral health team" (n=6). The scientific production showed low frequency of home visits, lack of prioritization and systematization of home care actions and weak interaction with the family health team. The home care protocols and instruments for the prioritization of home visits indicate the potential to overcome the clinical approach restricted to the dental office. Fourteen years into the publication of the National Oral Health Policy guidelines, the household is a territory to be conquered by the oral health team.