O estresse ocupacional na disfunção temporomandibular e a resolutividade das teleconsultorias em dor orofacial no Brasil / Occupational stress in temporomandibular dysfunctions and resolution of teleconsultings in orofacial pain in Brazil

As disfunções temporomandibulares (DTM) formam um grupo heterogêneo de condições musculoesqueléticas que atingem a face em suas estruturas mastigatórias, causando limitação funcional ou dor que compõe uma categoria das dores orofaciais. Elas têm etiologia multifatorial, além serem reconhecidas como um problema de saúde pública. Por sua vez, a teleconsultoria assíncrona em saúde visa ao esclarecimento de dúvidas remetidas por profissionais de saúde aos núcleos de telessaúde, contemplando, dentre vários aspectos, diagnósticos e procedimentos clínicos. Com o advento da pandemia da COVID-19, o serviço ganhou nova dimensão, com potencial para permanecer como relevante ferramenta pós-pandemia. O presente trabalho utilizou duas abordagens metodológicas. A primeira teve o objetivo de desenvolver uma revisão sistemática sobre as relações entre estresse no trabalho ­ uma categoria de estresse - e as DTM. As buscas foram realizadas nas bases de dados Pubmed, Scopus, Web of Science, Lilacs, Embase, Google Scholar e Opengrey. Foi elaborada uma análise da qualidade metodológica dos artigos originais e de suas medidas de associação. A segunda avaliou por um estudo transversal a resolutividade de teleconsultorias nacionais assíncronas em DTM/dor orofacial do Programa Telessaúde Brasil Redes. Utilizou-se o banco de dados secundários do Sistema de Monitoramento e Avaliação de Resultados do Telessaúde (SMART), do período de 2019 a 2020 (antes e durante a pandemia de COVID-19). A variável dicotômica "Se evitou encaminhamento para atenção secundária" foi considerada o desfecho, representando a resolutividade do programa de teleconsultorias, confrontada com covariáveis de sexo e profissão dos demandantes, além das categorias de suas demandas. Foram elaborados uma análise descritiva dos dados, por meio de frequência, e um modelo de regressão binomial negativa para estimar as razões de prevalência não ajustadas e ajustadas (RP) com o intervalo de confiança de 95%. Como resultados da revisão sistemática, 12 de 602 artigos originais foram selecionados. Metade encontrou uma associação entre estresse no trabalho e DTM; sons da ATM (um sinal de DTM) e o estresse no trabalho foram associados apenas em uma população de músicos. Apenas 3 dos estudos usaram ferramentas validadas tanto para estresse quanto para DTM. Já para o estudo transversal, foram avaliadas 2.629 teleconsultorias, sendo 1.982 referentes a 2019 (75,4%). Em 2019, 1.522 (76,8%) evitaram o encaminhamento para a atenção secundária e, em 2020, 373 (57,7%) o fizeram. Os cirurgiões-dentistas (33,1%) e médicos (55,1%) compuseram a maioria de demandantes, e as dúvidas odontológicos (39,6%) e "outras" (58%) foram as mais frequentes. Como conclusão, a revisão sistemática mostrou baixa evidência para a associação entre estresse no trabalho e DTM, dado o número limitado de artigos e várias deficiências metodológicas. O estudo transversal evidenciou o efeito da pandemia na distribuição das variáveis na amostra em 2020, assim como uma maior resolutividade para mulheres, dentistas e demandas associadas à odontologia no mesmo período.

Temporomandibular dysfunctions (TMD) comprise a heterogeneous group of musculoskeletal conditions that reach the face in their masticatory structures, causing functional limitation or pain that makes up a category of orofacial pain. They have multifactorial etiology and are a public health problem. In turn, asynchronous teleconsulting in health aims to clarify health problems referred by health professionals to telehealth, including, among various aspects, the diagnostic and clinical procedures. With the advent of the COVID-19 pandemic, the service gained a new dimension, potentially remaining a relevant post-pandemic tool. The present work used two methodological approaches. The first aimed to develop a systematic review on the relationship between work stress ­ a stress category ­ and TMD. Searches were performed in Pubmed, Scopus, Web of Science, Lilacs, Embase, Google Scholar, and Opengrey databases. In addition, an analysis of the original articles' methodological quality and their association measures was carried out. By a cross-sectional study, the second evaluated the resolution of asynchronous national dental teleconsultations of the Telessaúde Brasil Redes Program. The secondary database of the Telehealth Results Monitoring and Evaluation System (SMART, in the Portuguese acronym) from 2019 to 2020 (before and after the COVID-19 pandemic) was used. The dichotomous variable "If referral to secondary care was avoided" was considered the outcome, compared with sex and professional covariates of the users, in addition to categories of the claims. A descriptive data analysis was developed using frequency data and a negative binomial regression model to estimate the unadjusted and adjusted prevalence ratios (PR) with the corresponding 95% confidence interval. As a result of the systematic review, 12 of 602 original articles were selected. Half found an association between work stress and TMD; ATM sounds (a DTM signal) and stress at work were associated only in a population of musicians. In addition, only three studies used validated tools for both stress and TMD. As for the cross-sectional study, a total of 2,629 teleconsultations were evaluated, of which 1,982 refer to 2019 (75.4%). In 2019, 1,522 (76.8%) avoided referral to secondary care, and in 2020, 373 (57.7%) did so. Dentists (33.1%) and physicians (55.1%) made up the majority of claimants, and dental doubts (39.6%) and "others" (58%) were the most frequent. In conclusion, given the limited number of articles and several methodological deficiencies, the systematic review showed minimal certainty of the evidence for the association between work stress and TMD. The cross-sectional study showed the effect of the Pandemic on the distribution of variables in the sample in 2020, as well as a higher resolution for women, dentists, and doubts associated with dentistry in the same period.

Factors associated with toothache among Brazilian adults: a multilevel analysis

Abstract The aim of this study was to evaluate the factors associated with toothache in the adult population of Minas Gerais, Brazil. Individual data from a population sample (age 35 to 44 years) were collected from a secondary database of the SB Minas survey. Sampling was carried out by clusters and with multiple drawing stages. The eligibility criteria were to reside in areas chosen for the research, be within the age group, and accept to participate in the research. The individual variables assessed by a questionnaire and dental exams were sex, income, race/skin color, root caries, periodontal condition, need for dental treatment, and last dental appointment. The contextual variables, assessed by municipal indexes, were Human Development Index (HDI), illiteracy, unemployment, half minimum wage, quarter minimum wage, oral health team coverage, access to individual health care, and supervised tooth brushing average. The dependent variable was toothache in the past six months. A descriptive analysis was made using the Statistical Package for the Social Sciences and Hierarchical Linear and Nonlinear Modeling Software was used to perform the multilevel analyses for individual and contextual levels. An association was found between toothache and low income (OR = 2.00; 95%CI = 1.32-3.13), dental caries (OR = 1.86; 95%CI = 1.22-2.86), periodontal condition, and living on a quarter of the minimum wage or less (OR = 1.03; 95%CI = 1.00-1.08). Clinical and social factors were associated with toothache, reinforcing the need to improve public polices in oral health focused on the adult population.