COVID-19 em pessoas com deficiências do desenvolvimento: uma revisão de escopo / COVID-19 en personas con trastornos en el desarrollo: una revisión de alcance / COVID-19 in people with developmental disabilities: a scoping review

Resumo Objetivo Examinar a evidência emergente sobre os tipos e a frequência de deficiências do desenvolvimento na população afetada pela COVID-19, identificando formas de categorização, incidência/prevalência e comorbidades mais frequentes. Métodos Para esta revisão de escopo realizou-se busca por estudos observacionais nas bases de dados Medline (PubMed), Scopus (Elsevier), ISI Web of Science (Clarivate), Lilacs (BVS) e 'literatura cinzenta'. Como critérios de elegibilidade, os estudos deveriam apresentar resultados de ocorrência de deficiência de desenvolvimento em pessoas com COVID-19, permitindo comparação com a população em geral, ou entre os grupos de deficiências. Dois revisores independentes fizeram o mapeamento das informações utilizando um instrumento de extração de dados previamente elaborado. Outros dois pesquisadores verificaram os dados e auxiliaram na elaboração dos quadros de apresentação dos resultados. Resultados Observou-se diversidade de terminologias empregadas para categorizar as DD. As pessoas com DD e com comorbidades que representam maior risco para a COVID-19 necessitaram de internação hospitalar com maior frequência do que a população em geral. De um total de 4930 estudos, 14 foram selecionados para avaliação. Destes, 5 artigos foram estudos longitudinais. Conclusão Em pessoas com DD, a COVID-19 apresentou taxas de morbidade, letalidade e mortalidade mais altas em faixas etárias mais jovens, na população mais pobre, na população institucionalizada e que requer tecnologias de suporte de vida e cuidados especializados. A vulnerabilidade das pessoas com DD à COVID-19 depende do tipo e da gravidade da deficiência e da presença de comorbidades, evidenciando a necessidade de atenção no diagnóstico e nas medidas preventivas, como a vacinação.

Resumen Objetivo Examinar la evidencia emergente sobre los tipos y la frecuencia de trastornos en el desarrollo (TD) en la población afectada por COVID-19 e identificar formas de categorización, incidencia/prevalencia y comorbilidades más frecuentes. Métodos Para esta revisión de alcance se realizó una búsqueda de estudios observacionales en las bases de datos Medline (PubMed), Scopus (Elsevier), ISI Web of Science (Clarivate), Lilacs (BVS) y 'literatura gris'. Como criterio de elegibilidad, los estudios debían presentar resultados de casos de TD en personas con COVID-19 y permitir la comparación con la población general, o entre los grupos de trastornos. Dos revisores independientes realizaron el mapeo de la información con la utilización de un instrumento de extracción de datos previamente elaborado. Otros dos investigadores verificaron los datos y ayudaron a elaborar los cuadros de presentación de resultados. Resultados Se observó diversidad en la terminología empleada para categorizar los TD. Las personas con TD y con comorbilidades que representan mayor riesgo de COVID-19 necesitaron internación hospitalaria con mayor frecuencia que la población general. De un total de 4930 estudios, 14 fueron seleccionados para el análisis, de los cuales 5 artículos fueron estudios longitudinales. Conclusión En personas con TD, el COVID-19 presentó índices de morbilidad, letalidad y mortalidad más altos en rangos de edad más jóvenes, en la población más pobre, en la población institucionalizada y que requiere tecnologías de soporte vital y cuidados especializados. La vulnerabilidad de las personas con TD depende del tipo y gravedad del trastorno y de la presencia de comorbilidades, lo que deja en evidencia la necesidad de atención en el diagnóstico y en las medidas preventivas, como la vacunación.

Abstract Objective To examine the emerging evidence on developmental disability type and frequency in the population affected by COVID-19, identifying more frequent forms of categorization, incidence/prevalence and comorbidities. Methods For this scoping review, we searched for observational studies in the MEDLINE (PubMed), Scopus (Elsevier), ISI Web of Science (Clarivate), LILACS (VHL) and grey literature databases. As eligibility criteria, studies should present results of developmental disability (DD) occurrence in people with COVID-19, allowing comparison with the general population, or between groups of disabilities. Two independent reviewers mapped the information using a previously elaborated data extraction instrument. Two other researchers verified the data and assisted in table elaboration to present the results. Results There was a diversity of terminologies used to categorize DD. People with DD and comorbidities that represent a higher risk for COVID-19 required hospitalization more frequently than the general population. Out of a total of 4930 studies, 14 were selected for assessment. Of these, 5 articles were longitudinal studies. Conclusion In people with DD, COVID-19 had higher morbidity, lethality and mortality rates in younger age groups, in the poorest population, in the institutionalized population, requiring life support technologies and specialized care. The vulnerability of people with DD to COVID-19 depends on disease type and severity and the presence of comorbidities, highlighting the need for attention in diagnosis and preventive measures, such as vaccination.

Factors associated with edentulism in individuals with chronic kidney disease undergoing hemodialysis: a cross-sectional study / Fatores associados ao edentulismo em indivíduos com doença renal crônica em hemodiálise: um estudo transversa

Introduction: Chronic kidney disease (CKD) is a progres-sive condition characterized by structural or functional abnormalities of the kidney. CKD may be associated with several oral alterations, such as higher prevalence rate of dental caries, periodontal disease, xerostomia, candidiasis and burning mouth. The aim of the study was to identify risk factors associated with edentulism in adults with CKD undergoing hemodialysis. Methods: A cross-sec-tional study was conducted with 650 individuals aged 18 to 90 years undergoing hemodialysis in southeastern Brazil. Oral clinical examination and administration of a questionnaire addressing demographic characteristics and dental history were performed. The study received approval from the Human Research Ethics Committee of UFMG. Findings: A total of 183 participants were eden-tulous (28.2%). Individuals with less schooling (OR = 3.99; 95% CI: 2.34-6.79), those who had not been to a dentist in the previous six months (OR = 2.49; 95% CI: 1.52-4.08), those who rated their own smile as excellent or good (OR = 2.00; 95% CI: 1.35-2.97) and those with some mucosal alteration (OR = 4.17; 95% CI: 2.83-6.13) had a greater chance of belonging to the edentulous group. Discussion: The present findings can contribute to the establishment of public health policies aimed at guiding dental care programs for individuals with chronic kidney disease that take into account the specific needs of this population. Conclusion: Edentulism was associated with low schooling, a lack of dental care in the previous six months, a positive self-perception of one's smile and alterations in the oral mucosa.

Introdução: A doença renal crônica (DRC) é uma condição caracterizada por anormalidades estruturais ou funcionais do rim. A DRC pode estar associada a diversas alterações bucais, como maior prevalência de cárie dentária, doença periodontal, xerostomia, candidíase e queimação bucal. O objetivo deste estudo foi identificar os fatores de risco associados ao edentulismo em indivíduos com DRC em tratamento com hemodiálise. Materiais e Métodos: Foi realizado um estudo transversal com 650 indivíduos de 18 a 90 anos em hemodiálise no sudeste do Brasil. Foi realizado exame clínico oral e aplicação de questionário abordando características demográficas e histórico odontológico. O estudo foi aprovado pelo Comitê de Ética em Pesquisa em Seres Humanos da UFMG. Resultados: Um total de 183 participantes eram edêntulos (28,2%). Indivíduos com menor escolaridade (OR = 3,99; IC 95%: 2,34-6,79), aqueles que não foram ao dentista nos últimos seis meses (OR = 2,49; IC 95%: 1,52-4,08), aqueles que avaliaram o seu próprio sorriso como excelente ou bom (OR = 2,00; IC 95%: 1,35-2,97) e aqueles com alguma alteração de mucosa (OR = 4,17; IC 95%: 2,83-6,13) tiveram maior chance de pertencer ao grupo de edêntulos. Discussão: Os presentes achados podem contribuir para o estabelecimento de políticas públicas de saúde voltadas a nortear programas de atenção odontológica à pessoa com doença renal crônica que atendam às necessidades específicas dessa população. Conclusão: O edentulismo esteve associado à baixa escolaridade, falta de atendimento odontológico nos últimos seis meses, sorriso autoavaliado positivo e alterações mucosas.

Prescriptions of analgesics and anti-inflammatory drugs in municipalities from a Brazilian Southeast state

Abstract The objective of this study was to describe dental prescriptions of non-steroidal anti-inflammatory drugs (NSAID), opioids, and analgesics dispensed by the Brazilian National Health System (BNHS, SUS in Portuguese) of a Southeastern state from January to December 2017, and to analyze their association with socioeconomic and oral health care services' characteristics at municipal level. Data were collected from the Brazilian Integrated Pharmaceutical Care Management System. Medicines were grouped according to the Anatomical Therapeutic Chemical Classification System. The total number of Defined Daily Doses (DDD) and DDD per 1,000 inhabitants (inhab.) per year were presented and compared between groups of municipalities. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25.0. The total number of NSAID, opioids, and analgesics prescriptions was 70,747 and accounted for 354,221.13 DDD. The most frequently prescribed medicine was ibuprofen (n = 24,676; 34.88%). The number of dental practitioners in the BNHS per 1,000 inhab. (p < 0.001), first dental appointment coverage (p = 0.010), oral health teams per 1,000 inhab. (p=0.022), and the proportion of rural population (p = 0.014) were variables positively associated with the number of DDD of NSAID per 1,000 inhab. per year. Bolsa Família program coverage per 1,000 inhab. (p = 0.022) was negatively associated with NSAID prescription. Regarding analgesics, first dental appointment coverage (p=0.002) and Bolsa Família program coverage per 1,000 inhab. (p = 0.012) were positively associated with DDD per 1,000 inhab. per year. In conclusion, dental prescriptions of analgesics and NSAID in the BNHS were associated with socioeconomic and oral health care services' characteristics.

Contextual and individual factors associated with dental pain in adolescents from Southeastern Brazil

Abstract The aim of this study was to assess the factors associated with dental pain in adolescents from the state of Minas Gerais, Brazil. Individual data on adolescents aged 15 to 19 years were collected from the SB Minas survey secondary database. Dental pain over the past 6 months, assessed by a questionnaire, was used as the dependent variable. Sex, income, skin color, prevalence of untreated dental caries, periodontal health, dental treatment needs, and time of last dental appointment were analyzed as individual covariates. Allocation factor, Human Development Index (HDI), Gini coefficient, illiteracy rate, unemployment, 50% and 25% of the Brazilian monthly minimum wage, primary healthcare coverage, oral health team coverage, access to individual healthcare, and supervised toothbrushing average rate were the analyzed contextual variables. A multilevel analysis was conducted for the individual and contextual variables. Statistical analyses used hierarchical linear and nonlinear modeling to infer an association between the different levels. Male adolescents had a lower prevalence of dental pain (OR = 0.53; 95%CI = 0.37-0.75). There was an association between dental pain and low income (OR = 1.58; 95%CI = 1.07-2.33), prevalence of untreated dental caries (OR = 1.25; 95%CI = 1.11-1.40), periodontal health (OR = 1.80; 95%CI = 1.04-3.09), and dental treatment needs (OR = 6.93; 95%CI = 3.96-12.14). Sociodemographic and clinical factors at the individual level were associated with the outcome but not with contextual variables. These findings reinforce the need to address these factors for effective community health actions.

Carious lesions recurrence in children with developmental disabilities: a longitudinal study

Abstract This study investigated the factors associated with new carious lesions in one-to five-year-old children with developmental disabilities. This was a retrospective cohort that evaluated 64 dental charts of individuals with caries or fillings in their first dental appointment. The dependent variable was the occurrence of a new carious lesion or restoration. Gender, age, mother's education, sugar consumption, oral hygiene, mouth breathing, reports of xerostomia, gingival status, use of psychotropic drugs, use of asthma drugs, history of asthma, bronchitis, reflux or seizures and having at least one sibling were covariates. Cox proportional hazards regression model was used to estimate the raw and adjusted hazard ratios with their respective 95% confidence interval. The average time that individuals remained free of dental caries/restoration was 79.49 months (95%CI: 64.37 to 92.61). Increase in sucrose consumption increased the rate of caries recurrence (HR = 1.16; 95%CI: 1.04 to 1.30). Individuals who had poor oral hygiene had higher rate of new dental caries (HR = 3.88; 95%CI: 1.22 to 12.37) compared to those with good oral hygiene. The presence of mouth breathing decreased the rate of recurrence of the disease when compared to the nasal breathing (HR = 0.32; 95%CI: 0.15 to 0.70). Oral health-related behaviors and nasal respiration influenced the rate of dental caries recurrence in individuals with developmental disabilities.

Integrality of care for hemodialysis patient in Brazil: an analysis of access to dental care / Integralidade do cuidado para pacientes brasileiros em hemodiálise: análise do acesso odontológico

Abstract The present study aimed to analyze factors associated with access of dental care services by Brazilian hemodialysis patients. A cross-sectional study was carried out with 467 hemodialysis patients aging from 19 to 90 years in two renal therapy centers located in the cities of Contagem and Belo Horizonte, Southeastern Brazil. Data were collected through an oral clinical examination of the patients and the application of a structured questionnaire. The dependent variable was the access to dental care, measured by the question "Have you consulted with a dentist in last six months?". The mean age of participants was 49.9 years. The average number of teeth present in the mouth was 19.3. An average of 1.5 teeth with dental caries cavities lesion was diagnosed among hemodialysis patients. One-third of the sample had gone to the dentist in the last six months (27.8%). The access to dental care was associated with formal education (OR = 1.5 [1.1-2.4]), professional advising to consult with a dentist (OR = 2.1 [1.2-3.8]) and prevalence of dental caries (OR = 2.1 [1.3-3.2]). Hemodialysis patients with eight or more years of formal education, who received professional advising to consult with a dentist and without dental caries cavities had higher chances obtaining access to dental care.

Resumo Este estudo objetivou analisar os fatores associados ao uso de serviços odontológicos por pacientes em hemodiálise. Foi realizado um estudo transversal com 467 pacientes em hemodiálise, na faixa etária de 19 a 90 anos, de Contagem e Belo Horizonte, região Sudeste do Brasil. Os dados foram coletados por meio de exame clínico bucal dos participantes e da aplicação de um questionário estruturado. A variável dependente foi o acesso odontológico, mensurado pela pergunta "Você foi ao dentista nos últimos seis meses?". A média de idade dos participantes foi de 49,9 anos. A média de dentes presentes na boca foi de 19,3. Uma média de 1,5 dentes com lesão de cárie cavitada foi diagnosticada entre os pacientes em hemodiálise. Um terço da amostra afirmou ter ido ao dentista nos últimos seis meses (27,8%). O acesso odontológico dos pacientes em hemodiálise foi associado à escolaridade (OR = 1,5 [1,1-2,4]), orientação profissional para ir ao dentista (OR = 2,1 [1,2-3,8]) e prevalência de cárie dentária (OR = 2,1 [1,3-3,2]). Os pacientes em hemodiálise com oito anos ou mais de escolaridade, que receberam orientação profissional para ir ao dentista e sem cárie dentária apresentaram maior chance de terem acesso odontológico.

Availability of Analgesic and Anti-Inflammatory Medicines in Primary Health Care

Abstract Objective: To describe and analyze the availability and factors related to the presence of analgesics and non-steroidal anti-inflammatory drugs in the Brazilian public primary healthcare system. Material and Methods: This was a cross-sectional study that evaluated 17,903 health units that participated in the National Program for Primary Care Access and Quality Improvement (2013-2014). The dependent variable was defined as the presence of metamizole, ibuprofen, and acetaminophen in a sufficient amount. The independent variables included the type of primary health care unit, the presence of a medication disposal area, the number of physicians, nurses, and dental practitioners; and the number of primary care units with family and oral health teams. For statistical analysis, unadjusted and adjusted Odds Ratio (OR) (95% CI) were presented. Results: The three medicines were available in 62.4% of the units. Regarding Health Clinics, the Basic Health Units (OR= 1.31, CI95% 1.18-1.44), Polyclinic (OR= 2.00, 95% CI, 1.15 -3.48), and others (OR= 1.37; 95% CI 1.14-1.63) had higher chances of availability of all three drugs. The presence of a disposal area (OR = 1.64, 95% CI 1.51-1.77) and the number of physicians (OR= 1.04, 95% CI 1.00-1.08), nurses (OR= 1.08, 95% CI 1.03- 1.13), and dental practitioners (OR= 1.09, 95% CI 1.04-1.14) increased the availability odds of the analyzed drugs in the service. Conclusion: The structure of the healthcare units and the higher number of professionals were positively associated with the availability of these drugs.

What increases the risk of dental traumatism in patients with developmental disabilities?

Abstract This study investigated risk factors for tooth injuries in individuals from a dental clinical reference service for patients with special needs in Belo Horizonte, MG, Brazil. This is a retrospective cohort study that evaluated 493 dental charts of individuals with or without tooth injuries at their first dental appointment. The dependent variable was the time of occurrence of new dental traumatic injuries and was measured in months. Gender, age, International Code of Diseases, mother's education, mouth breathing, hyperkinesis, pacifier use, thumb sucking, psychotropic drug use, tooth injuries at the first dental examination, involuntary movements, open bite, having one or more siblings and reports of seizures were the covariates. The Cox proportional hazards regression model was used to estimate the unadjusted and adjusted hazard ratios and their respective 95% confidence intervals. The average time that individuals remained free of dental traumatism was 170.78 months (95% CI, 157.89-183.66) with median of 216 months. The incidence of new events was 11.88%. The covariate associated with an increased risk of dental traumatism was a history of tooth injuries at the first dental appointment. The increase in dental trauma risk was 3.59 (95% CI, 1.94-6.65). A history of traumatic dental injury was the risk factor for the dental trauma found in this group of individuals with developmental disabilities.

Resumo Este estudo investigou os fatores de risco para traumatismo dentário em indivíduos da clínica odontológica de um serviço de referência para pacientes com necessidades especiais em Belo Horizonte, Brasil. Este é um estudo de coorte retrospectivo que avaliou 493 prontuários de indivíduos com ou sem traumatismo dentário em sua primeira consulta odontológica. A variável dependente foi o tempo de ocorrência de novas lesões traumáticas e foi mensurada em meses. Sexo, idade, Código Internacional de Doenças, educação materna, respiração bucal, hipercinese, uso de chupeta, sucção digital, uso de medicação psicotrópica, lesões dentárias no primeiro exame odontológico, movimentação involuntária, mordida aberta, ter um ou mais irmãos e relatos de convulsões foram

Errors in Antibiotic Therapy: Study with Dentist's Prescriptions in a Large Brazilian City

Objective: To evaluate errors in dental prescriptions of antibiotics for therapeutic purpose. Material and Methods: This was a descriptive study using a random and calculated sample of 366 prescriptions (July1 2011 to June 30 2012), from a total of 31 105 dental prescriptions, was surveyed in an important drugstore chain in a large Brazilian city. Data was validated by double entry in Epi-data (EpiData Assoc, Odense M, Denmark) and then analysed in SPSS (version 19.0, Chicago, IL, USA). Statistical analyses included the calculation of proportions with a 95% confidence interval (CI). Results: We identified 272 prescriptions for therapeutic purpose. Prescription errors involved spelling of the antibiotic name, dose, dosing intervals and duration of treatment. A total of 116 prescriptions (42.6%; 95% CI 36.9%-48.6%) were considered to be totally correct with regard to the generic name, dose, dosing interval and duration of the antibiotic therapy. Most of the antibiotics prescribed by dentists showed errors related to the name, dose, intervals and duration of treatment. Conclusion: These errors may compromise the effectiveness of drug therapy, contribute to microbial resistance and increase the risk of adverse events and costs of treatment.

Root fracture in patient in the pre-liver transplantation phase / Fratura de raiz em paciente em fase pré-transplante de fígado

ABSTRACT Liver transplantation is the treatment of choice for end-stage liver disease patients, and offers them the possibility of returning to active and longer life. A dental evaluation before transplantation is a recommended prerequisite to avoid oral infections, which can worsen the patient's overall situation. This case report refers to the root fracture of an anterior tooth in a patient who was undergoing dental treatment prior to liver transplantation. On clinical examination, the maxillary right central incisor (11) presented without color change, but with mobility in the buccolingual direction, slight flaring and extrusion, and fistula in the attached gingiva on the distal side of tooth 11. The patient reported that he had suffered a trauma in that region 30 years before. The radiographic examination showed a horizontal fracture of the middle third of the root, associated with bone damage, indicated by a radiolucent area at the distal surface of 11. The proposed treatment consisted of: scraping procedure and straightening of the distal surface, radical endodontic treatment of the coronal portion of the root, subsequent filling with Mineral Trioxide Aggregate and dental immobilization. The clinical and radiographic follow-up at three-monthly intervals allowed us to observe gradual regression of the lesion with bone formation, contributing to maintenance of the patient's general and emotional health, preserving his smile and quality of life.

RESUMO O transplante de fígado é o tratamento de escolha para o estágio final da doença hepática e oferece a possibilidade ao paciente de retorno a uma vida ativa e longa. Uma avaliação dentária antes do transplante é recomendada como pre-requisito para a eliminação de infecções orais, as quais podem piorar o quadro do paciente. Este relato de caso se refere a uma fratura radicular de dente anterior em um paciente em tratamento odontológico prévio ao transplante de fígado. No exame clínico, o incisivo central superior direito (11) apresentava-se sem alteração na coloração mas com mobilidade no sentido vestíbulo-lingual, ligeira vestibularização e extrusão, e fístula na gengiva inserida na distal do 11. O paciente relatou ter sofrido traumatismo na região há mais de 30 anos. Ao exame radiográfico, foi identificada uma linha de fratura radicular horizontal no terço médio, associada à lesão óssea indicada por uma área radiolúcida na superfície distal do 11. O tratamento proposto para o caso envolveu procedimentos de raspagem e alisamento subgengival da superfície distal, o tratamento endodôntico radical da porção coronária radicular com posterior obturação com Agregado Trióxido Mineral e imobilização dental. O acompanhamento clínico e radiográfico, em intervalos de três meses, permitiu observar a regressão gradual da lesão, com formação de osso no local, contribuindo para manutenção do quadro de saúde geral e emocional do paciente, preservando seu sorriso e sua qualidade de vida.

Perfil dos pacientes com deficiências de desenvolvimento sob atendimento odontológico em um projeto de extensão intersetorial / Profile of patients with developmental disabilities under dental care in an intersectoral extension project

Objetivo: Descrever o perfil dos pacientes atendidos em uma instituição filantrópica onde funciona o projeto de extensão "Atendimento Odontológico a Pacientes com Necessidades Especiais". Métodos: A amostra foi composta por 581 prontuários de pacientes com necessidades especiais de 0 a 33 anos de idade. Foram coletadas informações sobre as prevalências de cárie nas dentições decídua e permanente, gengivite, xerostomia, bruxismo, refluxo gastroesofágico, sexo, uso de medicação de ação central, uso de chupeta, sucção digital, alimentação e higiene bucal. Os dados foram analisados por meio da estatística descritiva e teste do qui-quadrado para verificação de associação entre diagnóstico e sexo. Resultados: 51,93% dos pacientes eram meninos, 71,42% possuíam paralisia cerebral, 12,36% tinham refluxo gastroesofágico, 49,30% usavam medicação anticonvulsivante. O diagnóstico de paralisia cerebral quadriespástica esteve associado ao sexo masculino. Dentre as alterações bucais, 4,86% dos casos apresentaram xerostomia. O uso da chupeta foi encontrado em 26,93% dos indivíduos e 18,05% chupavam o dedo. Alterações gengivais foram detectadas em 15,61% das fichas. Em relação à alimentação, 56,97% dos indivíduos consumiam açúcar acima do aceitável, e com relação à higiene bucal, 14,48% foram classificados como ruim e 17,57% moderada. Em 20,57% dos prontuários havia registro de dentes decíduos cariados e em 4,29% de dentes obturados. Do total de pacientes que possuíam dentes permanentes, 13,17% tinha dentes cariados e 7,75% possuía dentes obturados. A prevalência de cárie dentária é moderada com pequena proporção de dentes restaurados. A alimentação é rica em sacarose para quase 60% destes pacientes. Conclusão: os hábitos parafuncionais apresentam um percentual preocupante de prevalência. Por isso, estes pacientes possuem um perfil de doenças bucais com gravidade moderada e que devem ter um acompanhamento odontológico sistemático para que a prevalência de doenças bucais não aumente com o passar dos anos.(AU)

Aim: The present study aimed to describe the profile of the patients who received dental care at a philanthropic institution, within the project "Dental Care for Patients with Special Needs". Methods: This study was carried out by evaluating 581 records of patients with special needs from 0 to 33 years of age. Data were collected on the prevalence of caries in deciduous and permanent dentitions, gingivitis, xerostomia, bruxism, gastroesophageal reflux, sex, use of central action medication, pacifier use, digital suction, feeding, and oral hygiene. Data were analyzed using descriptive statistics and the chi-square test to verify an association between diagnosis and sex. Results: The results showed that 51.93% were boys, 71.42% had cerebral palsy, 12.36% had gastroesophageal reflux, and 49.30% used anticonvulsant medication. The diagnosis of quadrispastic cerebral palsy was associated with males. Xerostomia was observed in 4.86% of the cases. The use of pacifiers was present in 26.93% of the individuals, while 18.05% of the patients used to suck their finger. Gingival changes were detected in 15.61% of the records. In relation to food, 56.97% of the individuals consumed sugar above the acceptable amount, and when oral hygiene was considered, 14.48% were classified as poor and 17.57% as moderate. This study also identified 20.57% of decayed and 4.29% of filled deciduos teeth. Among the patients who had permanent teeth, 13.17% had decayed teeth, while 7.75% had filled teeth. It could therefore be concluded that the prevalence of dental caries is moderate with a small proportion of treated teeth. Diet is rich in sucrose for almost 60% of these patients. Conclusion: The parafunctional habits present a worrisome percentage of prevalence. Therefore, these patients have a profile of oral diseases with moderate severity and should undergo systematic dental follow-up so that the prevalence of oral diseases does not increase over the years.(AU)

Factors Associated with Gingivitis in Children with Developmental Disabilities

Objective: To investigate factors associated with gingivitis in children aged one to 13 years with developmental disabilities. Material and Methods: A total of 408 dental records were used to recover the data. Gingivitis was measured based on the Modified Gingival Index. Other variables were also analysed: gender, age, International Classification of Diseases (ICD) code, mouth breathing, history of gastroesophageal reflux, use of psychotropic drugs, reports of dry mouth, history of asthma, use of medications to treat asthma, oral hygiene, dental caries, and filled or missing teeth in deciduous or permanent dentition. For the purposes of this analysis, the individuals were categorized as with and without gingivitis. Variables with a p-value < 0.25 in the bivariate analysis were incorporated into the logistic regression models (ICD, reflux, oral hygiene, primary tooth decay or filling, mouth breathing, dry mouth and use of psychotropic drugs). Results: We found a 14.67% prevalence of gingivitis. Individuals with mouth breathing had a 2.574-fold (95% CI: (1.113-5.950) greater chance of exhibiting gingivitis. Individuals with moderate oral hygiene had a 2.763-fold (95% CI: 1.066 to 7.160) greater chance of exhibiting gingivitis, and individuals with poor oral hygiene had a 15.029-fold (95% CI: 3.705-60.965) greater chance of exhibiting gingivitis than those with good oral hygiene. Conclusion: Moderate or poor oral hygiene and mouth breathing are factors associated with gingivitis in a group of patients with developmental disabilities at a dental service in Belo Horizonte.

Risk factors for dental caries in children with developmental disabilities

Abstract The aim of the present study was to investigate risk factors for dental caries in children with developmental disabilities who were treated at a clinical reference service for patients with special needs in Belo Horizonte, MG, Brazil. This is a retrospective cohort study that evaluated 401 dental charts of individuals without dental caries or restorations in their first dental appointment. The dependent variable was the time of occurrence of new dental caries or restorations and was measured in months. Gender, age, International Code of Diseases (ICD), mother´s education, sugar consumption, use of fluoride toothpaste, oral hygiene, mouth breathing, reports of xerostomia, gingival status, use of psychotropic or asthma drugs, and history of asthma were covariates. The Cox proportional hazards regression model was used to estimate the raw and adjusted hazard ratios and their respective 95% confidence intervals. The average time that individuals remained free of dental caries/restoration was equal to 107.46 months (95%CI 95.41 to 119.51), with a median of caries-free children up to 94 months. For each point increase in the scale of sucrose consumption, the increase in caries risk was 1.07 (95%CI 1.01 to 1.15). Sucrose consumption was the only risk factor for dental caries found in this group of individuals with developmental disabilities.

Factors associated with bruxism in children with developmental disabilities

The aim of the present study was to investigate factors associated with bruxism in children aged from 1 to 13 years with developmental disabilities. A total of 389 dental records were examined. The bruxism analyzed was determined based on parental reports. The following variables were also analyzed: gender, age, International Code of Diseases (ICD), mouth breathing, history of gastroesophageal reflux, use of psychotropic drugs, gingival status, reports of xerostomia, hyperkinesis, pacifier use, thumb sucking and involuntary movements. For the purposes of analysis, the individuals were categorized as being with and without bruxism. Variables with a p-value < 0.25 in the bivariate analysis were incorporated into the logistic regression models. Females had a 0.44-fold (95%CI: 0.25 to 0.78) greater chance of exhibiting bruxism than males. Individuals with gastroesophageal reflux had a 2.28-fold (95%CI: 1.03 to 5.02) greater chance of exhibiting bruxism. Individuals with reported involuntary movements had a 2.24-fold (95%CI: 1.19 to 4.24) greater chance of exhibiting bruxism than those without such movements. Exhibiting involuntary movements, the male gender and gastroesophageal reflux are factors associated with bruxism in children with developmental disabilities.

Dental caries and endemic dental fluorosis in rural communities, Minas Gerais, Brazil / Carie dentaria e fluorose endemica em distritos rurais de Minas Gerais, Brasil

It is observational, analytical and cross-sectional aimed to evaluate the association between severity and prevalence of fluorosis and dental caries in rural communities with endemic dental fluorosis in the north state of Minas Gerais, Brazil, with fluoride concentrations in water up to 4.8 mg/L. Data were collected by one examiner (intra-examiner kappa, 0.96 to 0,95 for caries and fluorosis) after toothbrushing. The study included 511 individuals aged 7 - 22 years, categorized according to age: 7 - 9 years (n = 227), 10 to 12 years (n = 153), 13 to 15 years (n = 92), 16 to 22 years (n = 39). For the diagnosis of dental caries used the criteria of the World Health Organization to measure indices DMFT. For fluorosis used the index Thylstrup and Fejerskov (TF), dichotomized according to prevalence (TF = 0 and TF > 0) and severity (TF < 4 and TF > 5). In the two younger groups, the DMFT and its decay component were higher in the group with more severe fluorosis (p < 0.001). This association was not found among adolescents and adults (p > 0.05). The association was found between the conditions more severe fluorosis and caries in individuals under 12 years.

Trata-se de estudo transversal e analítico cujo objetivo foi avaliar a associação entre a prevalência e a gravidade da fluorose e da cárie dentária em municípios rurais com fluorose endêmica no norte do Estado de Minas Gerais, Brasil, com concentração de flúor nas águas de até 4,8 mg/L. Os dados foram coletados por um examinador (Kappa intra examinador, 0,96 para fluorose e 0,95 para cárie) após escovação dentária. Participaram do estudo 511 indivíduos, com idades de 7 a 22 anos, categorizados conforme faixa etária: 7 a 9 anos (n = 227), 10 a 12 anos (n = 153), 13 a 15 anos (n = 92), 16 a 22 anos (n = 39). Para o diagnóstico da cárie dentária, utilizaram-se os critérios da Organização Mundial da Saúde (OMS) para a mensuração do índice de Dentes Cariados, Perdidos e Obturados (CPO-D). Para a fluorose utilizou-se o índice de Thylstrup e Fejerskov (TF), dicotomizado segundo a prevalência (TF = 0 e TF > 0) e gravidade (TF < 4 e TF > 5).Nos dois grupos mais jovens, o CPO-D e seu componente cariado foram maiores no grupo com fluorose mais grave (p < 0,001). Essa associação não foi identificada entre os adolescentes e adultos (p > 0,05). A associação mais grave entre as condições cárie e fluorose foi encontrada em indivíduos com até 12 anos.

Factors associated with dental caries in the primary dentition of children with cerebral palsy

The aim of this study was to investigate factors associated with caries experience in the primary dentition of one- to five-year-old children with cerebral palsy. A total of 266 dental records were examined, and caries experience was measured by dmft. The following variables were also analyzed: gender, oral hygiene, history of gastroesophageal reflux, use of medications for gastroesophageal reflux, gingival status, sugar intake and reports of polyuria, excessive thirst and xerostomia. For analysis purposes, the individuals were categorized as those with and without caries experience and subcategorized into the following age groups: one year; two to three years; and four to five years. After bivariate analysis, variables with a p-value < 0.25 were selected for incorporation into the Poisson regression models. Considering the limitations of the protocol, the level of oral hygiene perceived on the first appointment was the only factor associated with caries experience among two-to-fiveyear-old children with cerebral palsy.

Fatores associados à automedicação em um serviço brasileiro de emergência odontológica / Factors associated with self-medication in a brazilian emergency dental service

Objetivo: investigar os fatores associados à automedicação por pacientes atendidos em um serviço de emergências odontológicas em Belo Horizonte, MG, Brasil. Métodos: foi aplicado um questionário entre 174 pacientes atendidos na emergência odontológica contendo informações referentes ao gênero, idade e questões específicas como consumo anterior de medicamentos, ervas medicinais ou outras substâncias para o alívio da sintomatologia dolorosa. O diagnóstico clínico foi definido por somente um dentista. Análise bivariada e regressão multivariada de Poisson com variância robusta foram realizadas no programa SPSS 18.0. O estudo foi aprovado pelo Comitê de Ética de Pesquisa em Humanos. Resultados: a média de idade foi de 32,6 (+12,0) anos e 51,8% eram mulheres. Entre os participantes do estudo, 81,7% relataram terem se automedicado. A idade (p=0,83), a duração da dor (p=0,21) e o gênero (p=0,85) não estiveram associados à variável resposta. A frequência da automedicação foi mais alta (p-0,04) entre indivíduos com pulpites agudas (86,8%) e abscessos periapicais (84,7%). Somente o diagnóstico clínico esteve associado à automedicação na análise multivariada de Poisson. Comparando a outros diagnósticos, indivíduos com pulpites relatam 2,3 mais chances de se automedicarem (IC95% 1.1-5.0; p=0.03). Conclusão: a automedicação é um problema de saúde pública preocupante entre o grupo estudado. O diagnóstico clínico é o único fator que influencia este fenômeno dentre a população estudada.

Objective: To investigate factors associated with self-medication by patients treated at a public emergency dental service in Belo Horizonte, MG, Brazil. Method: A questionnaire was applied to174 patients who have been treated in the emergency dental service, with information about gender, age and specific questions about previous consumption of medicines, medicinal herbs or other substances to relieve dental pain. Clinical diagnosis was established by a single dentist. Bivariate analysis and multivariate Poisson regression with robust variance were carried out in SPSS 18.0 software for Windows. The study was approved by the local Human Research Ethics Committee. Results: The mean age of the patients was 32.6 (±12.0) years and 51.8% were female. Among the participants in the survey, 81.7% reported self-medication. Age (p=0.83), duration of pain (p=0.21) and gender (p=0.85) were not associated. Frequency of self-medication was higher (p=0.04) among individuals with pulpitis (86.8%) and periapical abscess (84.7%). Only clinical diagnosis was associated with self-medication in the multivariate Poisson analysis. Patients with pulpitis reported 2.3 times more self-medication (IC95% 1.1-5.0; p=0.03) than individuals with other diagnoses. Conclusion: Self-medication was an important health problem in the studied this surveyed group. Clinical diagnosis was the only factor that influenced this phenomenon.

Beliefs and attitudes about endemic dental fluorosis among adolescents in rural Brazil

Objetivo: Compreender crenças e atitudes em relação à fluorose dentária de jovens residentes em região rural do Brasil. Procedimentos Metodológicos: Estudo qualitativo em que foram realizadas entrevistas semi-estruturadas com 23 adolescentes com fluorose dentária, 14 professores e três gestores públicos no município de São Francisco, MG, em 2002. Foram empregadas a técnica de análise de conteúdo e a teoria das representações sociais. Análise dos resultados: Pelas características organolépticas que imprime à água (sabor salgado, coloração esbranquiçada e turbidez) e sua associação com aspectos negativos relacionados ao uso doméstico, o carbonato é considerado a causa da fluorose por adolescentes e professores. Mesmo após o contato com pesquisadores que investigaram o fenômeno e que participaram da sua solução, a população continua a resistir em aceitar o flúor como causa do problema e não concorda plenamente com o uso de água de outras fontes por duvidar de sua qualidade. Conclusões: Percepções equivocadas em relação às causas da fluorose dentária e a dificuldade em custear o tratamento da água comprometem a implantação de suprimento de água de superfície não contaminada. Estratégias de educação em saúde devem ser implementadas paralelamente a soluções para captação de água de fontes alternativas não contaminadas em localidades afetadas pela seca.

Fatores de risco para a cárie em dentes decíduos de portadores de necessidades especiais / Risk factors for caries in temporary teeth in disabled children

Objetivo: Investigar a influência do uso de mamadeira, da idade,da escolaridade dos pais, da medicação de uso crônico, do gênero,da higienização realizada pelo paciente ou pelo responsável, daprévia orientação de cuidadores sobre higienização e doatendimento por profissionais de diversas áreas da saúde napresença de lesões cavitadas cariosas e restaurações em dentesdecíduos em portadores de paralisia cerebral.Método: Foram examinados 141 prontuários de criançasportadoras de paralisia cerebral atendidas pelo projeto“Atendimento Odontológico a Pacientes com NecessidadesEspeciais” da Faculdade de Odontologia-UFMG, oriundas daAssociação Mineira de Reabilitação e da Escola João Moreira Salles,em Belo Horizonte. Testes do qui-quadrado e regressão logísticaforam usados na análise estatística.Resultados: Houve associação da experiência de cárie com aidade (p=0,000) e o uso de mamadeira (p=0,002). Estes pacientesconsomem mamadeira por um período prolongado de suas vidas.Apesar disto, 67,4% dos participantes deste projeto nãoapresentaram lesões cariosas nem restaurações. As demaisvariáveis não apresentaram associação com a cárie dentária.Conclusão: A mamadeira e a idade são importantes fatores quepredispõem o portador de paralisia cerebral a desenvolver lesões de carie dentária.

Considerações sobre o cuidado odontológico do paciente sob o uso de antidepressivos inibidores seletivos da recaptação de serotonina / Considerations about the dental care of selective serotonin reuptake inhibitors' users

O consumo de antidepressivos inibidores Seletivos da Recaptação de Serotonina (SSRI's) aumentou, nos últimos anos, em todo o mundo. O sucesso deste medicamento se deve à sua eficácia e sua baixa incidência de reações adversas. Com o aumento do seu emprego, entretanto, os registros de reações adversas realcionadas aos disturbios hemorrágicos, especialmente no trato gastrointestinal, também têm sido mais freqüentes. Embora o evento parece ser raro, certas interações medicamentosas inspiram preocupação na comunidade médica. Entre essas interações, o uso concomitante de SSRI's e antiinflamatórios não esteróides (AINES), muito empregados na odontologia, despertam especial interesse e é o alvo desta revisão da literatura.