Describing the Oral Health of Warfarin Users. A Short Report

Aim: To describe the burden of oral diseases and of self-reported periodontal disease of patients under Oral Anticoagulation Therapy (OAT) with warfarin. Methods: A cross-sectional study was conducted. Validated questionnaires assessed self-reported periodontal disease and demographic variables. After calibration (Kappa > 0.80), an examiner evaluated dental caries and the need for dental prostheses. Statistical analysis involved proportions and measures of central tendency. Results: The sample consisted of 158 individuals, with a mean age of 58.8 years (SD = 12.1), of which 62.7% of the participants were women. The average DMFT (Decayed, Missing, and Filled Teeth) index was 22.9 (SD = 7.6), with the missing component being the highest (Mean = 16.23). The use of maxillary prosthesis (53.2%) was higher than mandibular (32.3%). The need for mandibular prosthesis reached 66.5%. The percentage of participants that referred gum disease, tooth migration, and tooth mobility was 29.6%, 37.4%, and 30.4%, respectively. Conclusions: The burden of oral diseases among individuals undergoing OAT is worrisome.

Objetivo: Describir la carga de enfermedades bucales y la enfermedad periodontal autorreportada de pacientes en tratamiento con anticoagulación oral con warfarina. Métodos: Se realizó un estudio transversal. Los cuestionarios validados evaluaron la enfermedad periodontal autoinformada y las variables demográficas. Después de la calibración (Kappa> 0.80), un examinador evaluó la caries dental y la necesidad de prótesis dentales. El análisis estadístico involucró proporciones y medidas de tendencia central. Resultados: La muestra estuvo formada por 158 individuos, con una edad media de 58.8 años (DE = 12.1), de los cuales el 62.7% de los participantes eran mujeres. El índice CPOD promedio fue de 22.9 (DE = 7.6), siendo el componente perdido el que más contribuyó al índice (Media = 16.23). El uso de prótesis maxilar (53.2%) fue mayor que el de prótesis mandibular (32.3%). La necesidad de prótesis mandibular alcanzó el 66.5%. El porcentaje de participantes que informaron enfermedad de las encías, migración de los dientes y movilidad de los dientes fue del 29.6%, 37.4% y 30.4%, respectivamente. Conclusiones: Las enfermedades bucales y la necesidad de rehabilitación oral entre los individuos sometidos a anticoagulación oral con warfarina fue motivo de preocupación.

What we know about antibiotics prescribed by dentists in a Brazilian southeastern state

Abstract The objective of this study was to analyze possible associations between antibiotic dental prescriptions in the public health service, health service characteristics, and social characteristics of the municipalities. Using the register of dispensing in the public health service of a state in the Southeast region of Brazil, in 2017 we analyzed patterns of antibiotic prescriptions by dentists. Data were obtained from the Integrated Pharmaceutical Services Management System (SIGAF, in Portuguese). The outcome variable was the number of Daily Defined Doses (DDD) per 1,000 residents/year in each municipality. CART (Classification and Regression Tree) technique was used to determine the influence of the following variables: populational social characteristics (Human Development Index, Gini Index, the proportion of rural population and proportion of families benefiting from the Bolsa Família Program) and oral health services characteristics (access to individual dental care, number of dentists and oral health teams per 1,000 residents, and percentage of preventive and restorative individual dental procedures. Data analysis was performed using IBM SPSS Statistics 21.0. Antibiotics were the medications most prescribed by dentists in the public health service, with penicillin being the most frequently prescribed class. The average DDD/1,000 residents/year for the 421 municipalities surveyed was 96.54 (range 0.008 and 619.660). Select factors were associated with antibiotic prescriptions including access to individual dental care (Adjusted p-value ≤0.001), a number of oral health teams/1,000 inhabitants (Adjusted p-value=0.001), and Gini Index (Adjusted p-value = 0.046). Access to oral health services and inequality were associated with the use of antibiotics.

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.

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.

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.