Resumption of brazilian oral medicine health care during the second period of the COVID-19 pandemic

Aim: This present study aims to compare the data from the Brazilian Unified Health System on the number of clinical consultations of Oral Medicine from the first 6 months (March-August 2020) of the COVID-19 pandemic in Brazil with the last 6 months (September-February 2020/2021) to update the data, verify the measures' effectiveness to return clinical activities in the following months. Methods: perform a literature review of recent articles that report the impact of the COVID-19 pandemic on Oral Medicine. Results: There was an increase in the number of Oral Medicine clinical consultations in the second half of the pandemic throughout Brazil (+64.2%), representing over 9,235 appointments in this period. Conclusion: measures for the return of health assistance and the practice of Telemedicine proved to be effective after the second period of the pandemic. Even so, strengthening security measures against the coronavirus is essential to ward off a new wave since the Omicron variant emerged in the country and, consequently, possible new lockdowns that might affect healthcare in Brazil

Photobiomodulation for Oral Mucositis - A Microcosting and Budget Impact Analysis from a Brazilian Perspective

ABSTRACT Objective: To measure the costs of preventive and therapeutic protocols of Photobiomodulation (PBM) for oral mucositis (OM) and their budgetary impact on Brazil's Ministry of Health (BMH). Material and Methods: A partial economic analysis was performed to estimate the costs using a bottom-up approach from a social perspective. Monetary values were assigned in Brazilian reais (BRL). The costs of the preventive protocol were calculated for five, 30, and 33 consecutive PBM sessions, depending on the antineoplastic treatment instituted. The costs of the therapeutic protocol were calculated for 5 or 10 sessions. The annual financial and budgetary impact was calculated considering the groups of oncologic patients with a higher risk of development of OM, such as those with head and neck and hematological cancer and pediatric patients. Results: The cost of a PBM session was estimated at BRL 23.75. The financial impact of providing one preventive protocol per year for all oncologic patients would be BRL 14,282,680.00, 0.030% of the estimated budget for hospital and outpatient care of the BMH in 2022. The financial and budgetary impacts of providing one treatment for OM for all patients in one year would be BRL 2,225,630.31 (0.005%, most optimistic scenario) and BRL 4,451,355.63 (0.009%, most pessimistic scenario). Conclusion: The budgetary impact of implementing PBM protocols in the Brazilian Healthcare System is small, even in a pessimistic scenario.

The continuous increase in the number of systemic lupus erythematosus cases in Brazil in the COVID-19 era

Abstract This study aims to reevaluate and compare the data from the Brazilian Unified Health System (SUS) on the number of diagnoses of systemic lupus erythematosus (SLE) in the pre-pandemic period with those in the pandemic period, as well as to compare the first year (2020) of the COVID-19 pandemic in Brazil with the last year (2021), to update the data, and to verify whether SLE disease control measures were effective in 2021. There was a consistent and significant increase in the incidence of SLE cases all over Brazil between the first and second pandemic years and between the pre-pandemic triennium and the second pandemic year. Therefore, it is inescapable to have larger clinical studies with different populations to better understand the relationship between these two conditions and find measures to improve the control of this disease.

Economic Impact of the COVID-19 Pandemic among Dentists in One of the Poorest Brazilian States: A Cross-Sectional Study

ABSTRACT Objective: To analyze the impact of the COVID-19 pandemic on dentists' income and to identify associated factors in one of the poorest Brazilian states. Material and Methods: A cross-sectional study including dentists who volunteered to answer an electronic questionnaire in Maranhão. Hierarchical multinomial logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95%CI) (alpha=5%). Results: The COVID-19 pandemic impacted the professionals´ income negatively [55.44% (50.26-60.52%)] and also positively [6.9% (4.55-9.94%)]. The negative impact on income was greater among male dentists (OR=2.54; 95%CI: 1.16-5.53), over 30 years of age (OR=3.03; 95%CI: 1.34-6.87), with family income below two minimum wages (OR=4.63; 95%CI: 1.50-14.30), who worked in the continent instead of in the capital island (OR=2.21; 95%CI: 1.14-4.29) and in the private sector (OR=31.43; 95%CI: 11.59-85.22). Moreover, those who had been tested for COVID-19, with a negative result, had a 21.3-fold greater chance of having an increased household income when compared to those who had not been tested. Conclusion: The COVID-19 pandemic negatively impacted the dentists' income in Maranhão, especially the older, males, with lower incomes, and who worked in the private sector, living far from the capital. The SUS played an important role in the social protection of dentists during the COVID-19 pandemic, mitigating the economic impacts on the public sector working class.

Estudo comparativo entre indicadores assistenciais de saúde bucal na Atenção Básica em Recife, Pernambuco / Oral healthcare comparative study among indicators in Primary Care, in Recife, Pernambuco

RESUMO A rede de atenção à Saúde Bucal (SB) se ampliou com a Política Nacional de Saúde Bucal, sendo os indicadores ferramentas para avaliar conquistas ou necessidade de mudanças. Este trabalho objetivou analisar indicadores de SB da Atenção Básica por tipo de organização das unidades de saúde em Recife, 2018. Trata-se de um estudo transversal, de natureza descritiva e analítica com base em dados secundários. Analisou-se a associação entre tipos de organização da Atenção Básica (Unidade de Saúde da Família - USF; Upinha e Unidade Básica Tradicional - UBT) e indicadores assistenciais de SB, através dos testes qui-quadrado e Kruskal-Wallis (p<0,05). A cobertura de primeira consulta odontológica e os procedimentos odontológicos per capita apresentaram mediana maior nas UBT, 31,8% (p=0,00) e 0,6 (p=0,127), respectivamente. A proporção de exodontia e procedimentos clínicos foi maior nas USF com mediana 8,2% (p=0,703). As USF foram as que realizaram o maior número de atividades coletivas de escovação dental supervisionada (45,3%, p=0,082) e aplicação de flúor (44,6%, p=0,174). Conclui-se que as UBT apresentaram melhores resultados nos indicadores relacionados ao acesso ao tratamento clínico e as USF realizaram mais ações coletivas de prevenção.

ABSTRACT The Oral Health care network (OH) has expanded with the National Oral Health Policy, and the indicators are tools to assess achievements or the need for changes. This study aimed to analyze the OH indicators of Primary Care Basic by health units organization type in Recife, 2018. This is a cross-sectional, quantitative, descriptive and analytical study, based on secondary data. The association between organization type of Primary Care (Family Health Unity/USF; Upinha and Traditional Basic Health Unit/UBT) and OH assistance indicators was analyzed using the chi-square and Kruskal-Wallis tests (p<0,05). The first dental appointment coverage and the average number of procedures per capita showed a higher median in the UBT, 31,8% (p=0,00) and 0,6 (p=0,127), respectively. The tooth extraction proportion was higher in the USF, with a median of 8,2% (p=0,703). The USF were the ones that performed the largest number of collective activities of supervised tooth brushing (45.3%, p=0.082) and fluoride application (44.6%, p=0.174). It is concluded that the UBT showed better results in the indicators related to access to clinical treatment and the USF performed more collective activities.

Diagnosis of mucosal changes and hospitalized oral cancer patients in Brazil: influence of socioeconomic factors

Abstract This study aimed to analyze the influence of socioeconomic factors on the frequency of diagnoses of oral mucosal changes and the number of hospitalized patients with oral and oropharyngeal cancer in Brazil. This cross-sectional study analyzed data from all Brazilian cities in the period 2011-2017. The frequency of diagnoses of oral mucosal changes and the number of hospitalized patients of oral and oropharyngeal cancer in Brazil were extracted from the Primary Care Information System (SIAB) and Brazilian National Cancer Institute (INCA) databases. The socioeconomic factors evaluated were the Gini coefficient of inequality, municipal Human Development Index (MHDI), inadequate basic sanitation rate, employment rate, illiteracy rate and expected years of schooling. Associated factors were examined using bivariate Spearman's correlations and multivariate Poisson regressions, and statistically significant (p < 0.05) correlations between study variables and regression coefficients were obtained. A higher frequency of diagnoses of mucosal changes was observed in cities with a higher Gini coefficient (B = 11.614; p < 0.001), higher MHDI (B = 11.298; p < 0.001), and higher number of hospitalized patients with oral and oropharyngeal cancer (B = 0.001, p < 0.002). Cities with higher Gini coefficients (B = 8.159, p < 0.001), higher inadequate basic sanitation rates (B = 0.09, p = 0.001), lower expected years of schooling (B = -0.718, p < 0.001), and higher illiteracy rates (B = 0.191, p < 0.001) had a higher frequency of hospitalized patients with oral and oropharyngeal cancer. In conclusion, more developed cities showed a higher frequency of diagnoses of mucosal changes. Greater inequality and worse socioeconomic conditions are associated with a higher frequency of hospitalized patients with oral and oropharyngeal cancer in Brazil.

PNAB 2017 and the number of community health agents in primary care in Brazil / A PNAB 2017 e o número de agentes comunitários de saúde na atenção primária do Brasil

ABSTRACT OBJECTIVE: To analyze the effect of the 2017 Basic Primary Care Policy (PNAB) on the number of community health agents per primary health care team. METHODS: This is a cross-sectional, descriptive and analytical study using data available on the Ministry of Health platform called e-Gestor da Atenção Básica, about Brazil's 5,570 towns between October 2017 and December 2019. The survival of the number of towns that did not reduce the number of community health agents was analyzed according to region of the country, the Human Development Index (HDI), the Gini Inequality Index and population size. Cox regression was used to analyze the factors associated with a reduction in the number of CHAs after one month and, from then on, every three months until two years had passed since the publication of the 2017 PNAB Ordinance, considering p < 0.05. CONCLUSIONS: After two years, the greatest reduction was observed in towns in the Midwest and South regions, which presented a high HDI, lower inequality and larger populations. Towns in the Midwest (HR = 1.256) had a higher chance of reducing the number of CHAs compared to the North region. Towns with a higher HDI (HR = 1.053) and larger population size (HR = 1.186) were also more likely to reduc the number of community health agents. Therefore, after the 2017 PNA, the number of towns reducing the amount of community health workers in primary health care increased over the months

RESUMO OBJETIVO: Analisar o efeito da Política Nacional de Atenção Básica (PNAB) de 2017 no quantitativo de agentes comunitários de saúde, por equipe de atenção primária em saúde. MÉTODOS: Trata-se de um estudo transversal, descritivo e analítico, utilizando dados disponibilizados na plataforma e-Gestor da Atenção Básica, do Ministério da Saúde, sobre os 5.570 municípios brasileiros, entre outubro de 2017 e dezembro de 2019. A sobrevida do número de municípios que não reduziram o quantitativo de agentes comunitários de saúde foi analisada segundo a região do país, índice de desenvolvimento humano (IDH), índice de desigualdade de Gini e porte populacional. A Regressão de Cox foi utilizada para analisar os fatores associados à redução do número de ACS após um mês e, a partir de então, a cada três meses, até completarem os dois anos da publicação da portaria da PNAB 2017, considerando-se p < 0,05. CONCLUSÕES: Após dois anos, a maior redução foi observada em municípios das regiões Centro-Oeste e Sul, que apresentaram IDH alto, menos desiguais e com maior porte populacional. Municípios do Centro-Oeste (HR = 1,256) apresentaram maior chance de redução do número de ACS comparado à região Norte. Municípios com maior IDH (HR = 1,053) e maior porte populacional (HR = 1,186) também apresentaram maior chance de reduzir o número de agentes comunitários de saúde. Portanto, após a PNAB 2017, houve um aumento ao longo dos meses no número de municípios que reduziram a quantidade de agentes comunitários em saúde na atenção primária de saúde.

Acesso em saúde bucal no Brasil: análise das iniquidades e não acesso na perspectiva do usuário, segundo o Programa de Melhoria do Acesso e da Qualidade da Atenção Básica, 2014 e 2018 / Acceso a la salud oral en Brasil: análisis de desigualdades y falta de acceso desde la perspectiva del usuario, según Programa para Mejorar el Acceso y la Calidad de la Atención Primaria, 2014 y 2018 / Oral health access in Brazil: analysis of inequities and non-access from the service user's perspective, according to the National Primary Care Access and Quality Improvement Program, 2014 and 2018

Objetivo: Investigar os fatores associados ao não acesso em saúde bucal no Brasil. Métodos: Estudo transversal, sobre dados da avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, em 2014 e 2018, mediante regressão logística multivariada hierarquizada. Definiu-se como 'não acesso' quando o usuário não consegue marcar consulta com cirurgião-dentista. Resultados: Foram analisados dados de 37.262 indivíduos do segundo ciclo (2014) e 117.570 do terceiro ciclo (2018). Maior chance de não acesso ocorreu para residentes em municípios mais desiguais e com menor cobertura de saúde bucal, deslocamento para a unidade de saúde superior a 11 minutos, sexo feminino, idade entre 25 e 39 anos e renda de até 1 salário mínimo. Conclusão: O não acesso associou-se a fatores municipais, como maior desigualdade; fatores organizacionais, como menor cobertura e tempo de deslocamento até a unidade; e fatores individuais, como sexo, idade e renda.

Objetivo: Investigar los factores asociados a la falta de acceso a la salud bucal en Brasil. Métodos: Estudio transversal, con datos de la evaluación externa del Programa de Mejoramiento del Acceso y la Calidad de la Atención Primaria (2014 y 2018), mediante regresión logística multivariable jerárquica. La categoría 'sin acceso' se definió cuando el usuario no consiguió concertar una consulta con un cirujano dentista. Resultados: Analizamos datos de 37.262 (2014) y 117.570 (2018) individuos. Se encontró una mayor probabilidad de no acceso para quienes: vivían en municipios con más desigualdad y con menor cobertura de salud bucal, cuyo tiempo de viaje a la unidad era superior a 11 minutos; mujeres, entre 25 y 39 años e ingresos de hasta 1 sueldo mínimo. Conclusión: La falta de acceso se asoció con factores municipales como mayor desigualdad; factores organizacionales como menor cobertura y tiempo de viaje a la unidad; y factores individuales como sexo, edad e ingresos.

Objective: To investigate factors associated with non-access to oral health in Brazil. Methods: This was a cross-sectional study of data from external evaluations of the National Primary Care Access and Quality Improvement Program (2014 and 2018), using hierarchical multivariate logistic regression. 'Non-access' was defined as the service user not being able to make an appointment with a dentist. Results: We analyzed data on 37.262 individuals (2014 sample) and on a further 117.570 individuals (2018 sample). Greater likelihood of non-access was found for those who live in municipalities with greater inequalities and with less oral health coverage, those whose travel time to the health center is more than 11 minutes, being female, being aged between 25 and 39 years and those whose income was up to 1 minimum wage. Conclusion: Non-access was associated with municipal factors such as greater inequality; organizational factors such as less oral health coverage and travel time to the health center; and individual factors such as sex, age and income.

Acesso e cobertura populacional à saúde bucal após a implementação da Política Nacional de Saúde Bucal "Brasil Sorridente" / Access and oral health population coverage after implementation of the National Oral Health Policy "Smiling Brazil" / Acceso y cobertura de la salud oral después de la implementación de la Política Nacional de Salud Oral "Brasil Sonriente"

O objetivo foi analisar a Política Nacional de Saúde Bucal, na perspectiva do acesso e cobertura das ações desenvolvidas na odontologia do Sistema Único de Saúde, entre 2002 e 2016. A partir do quadro conceitual da Organização Mundial da Saúde, que se divide em blocos para garantir acesso, cobertura e qualidade dos sistemas de saúde, foi realizado um estudo de caso do Brasil Sorridente referentes à implantação e financiamento das equipes. O bloco "força de trabalho" revelou um crescimento superior a 470% no número de equipes de saúde bucal no Brasil; no bloco "financiamento" fica evidente o grande aporte financeiro destinado à política, com ênfase ao papel indutor deste processo nos municípios; o bloco "tecnologia" evidenciou o incremento tecnológico para viabilizar os serviços de saúde bucal em todo o Brasil; já no bloco "disponibilidade dos serviços de saúde" observa-se uma ampliação de 4% na atenção básica e os serviços especializados essas porcentagens ultrapassam os 200% entre 2001 e 2015, finalmente, no bloco "acesso e cobertura" foi possível verificar o aumento de cobertura populacional de 9% para 43% no Brasil. Os dados apontam que a política permitiu um avanço referente aos blocos estruturantes do framework e melhorou o acesso e a cobertura em saúde bucal. (AU)

The objective was to analyze the National Oral Health Policy, from the perspective of access and coverage of dentistry actions in the Unified Health System, between 2002 and 2016. Based on the World Health Organization conceptual framework, which is divided into blocks to guarantee access, coverage and quality of health systems, a case study was carried out in the Smiling Brazil considering the implementation and financing. As a result, the "workforce" block revealed a growth rate superior than 470% in the number of oral health teams in Brazil. In the "financing" block, the great financial support to the policy is evident, with emphasis on the role of this process in the municipalities. The "technology" block evidenced the technological increase to make oral health services viable in Brazil. Furthermore, in the block "availability of health services" was observed an increase of 4% in primary care. On the other hand, between 2001 and 2015, in the specialized services this percentage exceed 200%. Finally, in the block "access and coverage" was possible to verify the increase of population coverage from 9% to 43% in Brazil. The data indicate that the policy allowed an advance regarding the framework structuring blocks, as well as improved the access and coverage in oral health. (AU)

El objetivo fue analizar la Política Nacional de Salud Oral, desde la perspectiva de acceso y cobertura de las acciones desarrolladas en la odontología del Sistema Único de Salud, entre 2002 y 2016. Desde el marco conceptual de la Organización Mundial de la Salud, que se divide en bloques para garantizar el acceso, la cobertura y la calidad de los sistemas de salud, se realizó un estudio de caso de Smiling Brazil sobre la implementación y el financiamiento de los equipos. El bloque de "fuerza laboral" reveló un crecimiento de más del 470% en el número de equipos de salud bucal en Brasil; En el bloque de "financiamiento", la gran contribución financiera a la política es evidente, con énfasis en el papel inductivo de este proceso en los municipios; el bloque "tecnología" evidenció el aumento tecnológico para habilitar los servicios de salud bucal en todo Brasil; En el bloque "disponibilidad de servicios de salud" hay un aumento del 4% en atención primaria y servicios especializados, estos porcentajes superan el 200% entre 2001 y 2015, finalmente, en el bloque "acceso y cobertura" fue posible verificar el aumento Cobertura poblacional del 9% al 43% en Brasil. Los datos indican que la política permitió un avance con respecto a los componentes básicos del marco y un mejor acceso y cobertura en salud bucal. (AU)

Monitoring of oral health teams after National Primary Care Policy 2017 / Monitoramento das equipes de saúde bucal após a Política Nacional de Atenção Básica 2017

ABSTRACT OBJECTIVE To monitor the number of oral health teams implemented in the Family Health Strategy after National Primary Care Policy 2017. METHODS This is a study of quantitative, descriptive and analytical nature that used the data from the public reports of the history of oral health coverage available in the e-Manager platform of Primary Care of the Ministry of Health of all Brazilian municipalities (5,570). The survival rate of the municipalities that did not reduce the number of oral health teams was analyzed according to the region of the country, human development index, Gini inequality index and population size. Cox regression was used to analyze the factors associated with the decrease in the number of teams implanted after 1, 3, 6, 9, 12, 15, 18 and 21 months of publication of the 2017 national policy ordinance, considering the hazard ratio (HR) and p < 0.05. RESULTS After 21 months of publication of the policy, 6.7% of Brazilian municipalities reduced the number of oral health teams. This reduction was higher in the South (6.7%) and Northeast (4.8%), in municipalities with the highest human development index, i.e., greater than or equal to 0.7 (5.6%), more unequal in terms of income distribution (Gini index > 0.62) and larger population size (more than 100,000 inhabitants). Municipalities in the Northeast (HR = 1.220) and South (HR = 1.771) regions had a higher chance of reducing the number of teams compared with those in the North region. More unequal municipalities (HR = 6.405) and with larger population size (HR = 4.273) were also more likely to reduce the coverage of oral health teams. CONCLUSION The municipalities that reduced the number of oral health teams in the Family Health Strategy are from the South and Northeast regions, with greater social inequality and larger population size. This scenario can significantly affect the population's access to dental health services in the Unified Health System, especially among those in need.

RESUMO OBJETIVO Realizar um monitoramento do quantitativo de equipes de saúde bucal implantadas na Estratégia Saúde da Família após a Política Nacional de Atenção Básica 2017. METODOLOGIA Estudo de natureza quantitativa, descritiva e analítica que utilizou os dados dos relatórios públicos do histórico de cobertura de saúde bucal disponível na plataforma e-Gestor da Atenção Básica do Ministério da Saúde de todos os municípios brasileiros (5.570). A sobrevida dos municípios que não reduziram o quantitativo de equipes de saúde bucal foi analisada segundo a região do país, índice de desenvolvimento humano, índice de desigualdade de Gini e porte populacional. A regressão de Cox foi utilizada para analisar os fatores associados à diminuição do número de equipes implantadas após 1, 3, 6, 9, 12, 15, 18 e 21 meses da publicação da portaria da política nacional de 2017, considerando-se a hazard ratio (HR) e p < 0,05. RESULTADOS Após 21 meses de publicação da política, 6,7% dos municípios brasileiros reduziram a quantidade de equipes de saúde bucal. Essa redução foi maior nas regiões Sul (6,7%) e Nordeste (4,8%), nos municípios com índice de desenvolvimento humano mais alto, ou seja, maior ou igual a 0,7 (5,6%), mais desiguais quanto à distribuição de renda (índice de Gini > 0,62) e de maior porte populacional (mais de 100.000 habitantes). Municípios das regiões Nordeste (HR = 1,220) e Sul (HR = 1,771) apresentaram maior chance de redução do número de equipes comparados aos da região Norte. Municípios mais desiguais (HR = 6,405) e com maior porte populacional (HR = 4,273) também apresentaram maior chance de reduzir a cobertura de equipes de saúde bucal. CONCLUSÃO Os municípios que reduziram a quantidade de equipes de saúde bucal na Estratégia Saúde da Família são das regiões Sul e Nordeste, com maior desigualdade social e maior porte populacional. Esse cenário pode impactar significativamente o acesso da população aos serviços de saúde bucal do Sistema Único de Saúde, principalmente entre os que mais necessitam.

Dental caries experience and associated factors in 12-year-old-children: a population based-study

Abstract Relevant public policies in oral health have been implemented in Brazil since 2004. Changes in the epidemiological status of dental caries are expected, mainly in the child population. This study aimed to assess the dental caries experience and associated factors among 12-year-old children in the state of São Paulo, Brazil. A cross-sectional population-based study was conducted with data obtained from 415 cities, including a total of 26,325 schoolchildren who were included by the double-stage cluster technique, by lot and by systematic sampling. The statistical model included data from the São Paulo Oral Health Survey (SBSP 2015), the Human Development Index (HDI) and the Social Vulnerability Index (SVI). A theoretical-conceptual model categorized the variables into three blocks, namely, contextual (HDI, SVI, region of residence and fluoridation of water), individual (sex and ethnicity) and periodontal conditions (gingival bleeding, dental calculus and the presence of periodontal pockets), for association with the experience of caries (DMFT). Statistically significant associations were verified by hierarchical multivariate logistic (L) and Poisson (P) regression analyses (p < 0.05). The results showed that 57.7% of 12-year-old children had caries experience. Factors that determined a greater prevalence of dental caries in both models were nonwhite ethnicity (ORL = 1.113, ORP = 1.154) and the presence of gingival bleeding (ORL = 1.204, ORP = 1.255). Male children (ORL = 0.920 ORP = 0.859) and higher HDI (ORL = 0.022), ORP = 0.040) were associated with a lower prevalence of dental caries experience. Water fluoridation was associated with a lower DMFT index (ORP = 0.766). Dental caries experience is still associated with social inequalities at different levels. Policymakers should direct interventions towards reducing inequalities and the prevalence of dental caries among 12-year-old children.

Atenção odontológica especializada para pessoas com deficiência no Brasil: perfil dos centros de especialidades odontológicas, 2014 / Atención odontológica especializada para personas con discapacidad en Brasil: perfil de los centros de especialidades odontológicas, 2014 / Specialized dental care for people with disabilities in Brazil: profile of the Dental Specialty Centers, 2014

Objetivo: Descrever os serviços de atenção à saúde bucal para pessoas com deficiência, atendidas pela especialidade Odontologia para Pacientes com Necessidades Especiais (PNE). Métodos: Estudo transversal, com dados do Programa de Melhoria do Acesso e Qualidade dos Centros de Especialidades Odontológicas (PMAQ-CEO), 2014. Resultados: Dos 932 serviços avaliados, 89,8% contavam com atendimento a PNEs, 30,4% apresentavam acessibilidade física e 59,7% contavam com referência para atendimento hospitalar. A maioria garantia tratamento completo. São disponibilizadas 40h semanais de atendimento clínico a PNEs em 1/3 dos CEOs. Conclusão: A rede de cuidado para pessoas com deficiência encontra-se em formação e, apesar dos incentivos financeiros específicos, apresenta limitações. Os serviços precisam eliminar barreiras físicas e atitudinais para garantir acessibilidade universal. Protocolos baseados em classificação de risco são necessários, priorizando atendimento no CEO dos casos complexos, não atendidos na Atenção Básica e organizando a rede de cuidados em saúde bucal da pessoa com deficiência.

Objetivo: Describir los servicios de atención a la salud bucal para personas con discapacidad, atendidos por la especialidad Odontología para Pacientes con Necesidades Especiales (PNE). Métodos: Estudio transversal, con datos del Programa de Mejora del Acceso y Calidad de los Centros de Especialidades Odontológicas (PMAC-CEO), 2014. Resultados: Se evaluaron 932 servicios: 89,8% contaba con atención a los PNEs, 30,4% tenía accesibilidad física y 59,7% tenía referencia para atención hospitalaria. La mayoría garantía tratamiento completo. Sólo 1/3 ofrecían 40hs semanales de atención PNE. Conclusión: La red de atención para personas con discapacidades se está formando, y a pesar de los incentivos financieros específicos, tiene limitaciones. Los servicios necesitan eliminar las barreras físicas y de actitud para garantizar la accesibilidad universal. Protocolos basados en clasificación de riesgo son necesarios, priorizando la atención en el CEO de los casos complejos, no atendidos en la atención básica y organizando la red de atención en salud bucal de la persona con discapacidad.

Objective: To describe the oral health care services for people with disabilities treated within the Dentistry for Patients with Special Needs (PSN) specialty. Methods: This was a cross-sectional study with data from the Program for Improving Access and Quality of Dental Specialty Centers (PMAQ-CEO) in 2014. Results: Of the total of 932 services evaluated, 89.8% did provide care for PSNs, 30.4% had physical accessibility, 59.7% provided referral to hospital care and most guaranteed complete treatment. Only a third of the Dental Specialty Centers planned 40 or more hours a week for providing clinical care to PSNs. Conclusion: The care network for people with disabilities is being formed but, even with specific financial incentives, it has limitations. Services need to eliminate physical and attitudinal barriers to ensure universal accessibility. Protocols based on risk classification are necessary, prioritizing care at DSCs for complex cases not attended to in Primary Care and organizing the dental health care network for people with disabilities.

Economic Impact of New Biosafety Recommendations for Dental Clinical Practice During COVID-19 Pandemic

Abstract COVID-19 pandemic implied new biosafety recommendations to avoid dissemination of SARS-CoV-2 virus within healthcare centers. Changes on recommended personal protective equipment (PPE), decontamination protocols and organization of patient demand resulted may result in cost variation. Based on this, the present study aimed to evaluate the economic impact of new biosafety recommendations for oral healthcare assistance during COVID-19. An Activity Based Costing evaluation was used to calculate the acquisition of PPE and decontamination solutions recommended for dental practice during COVID-19 pandemic in Brazil. PPE and decontamination solutions quantity and frequency of use were based on the newly COVID-19 recommendations. Costs (in Brazilian Real - R$) for biosafety recommendations pre- and post-COVID-19 were outlined and calculated for each patient, service shift and year. A sensitivity analysis considered 20% variation of direct costs. Previously to COVID-19 pandemic, direct costs of biosafety recommendations consisted of R$0.84 per patient, R$6.69 per service shift and R$3,413.94 per year. Post-COVID-19 costs of biosafety recommendations resulted in R$16.01 per patient, R$128.07 per service shift, and R$32,657.96 per year. Yearly costs can vary between R$26,126.37 and R$39,189.56. The annual budget increase necessary to adopt post-COVID biosafety recommendations was R$29,244.02. Newly biosafety recommendations increased significantly the costs of oral healthcare assistance during COVID-19 pandemic. Decision making of healthcare managers must consider rational and equity allocation of financial resources.

Teledentistry and the Unified Health System: An Important Tool for the Resumption of Primary Health Care in the Context of the COVID-19 Pandemic

Abstract This paper describes the possibilities of using Teledentistry to expand and qualify health care in oral health care networks. WHO already recommended to its member countries, even before the pandemic, Telehealth as a strategy to improve the quality of services, especially in universal systems, as the Unified Health System (SUS). Teledentistry opens opportunities for oral health to resume the provision of various services, remotely, such as: 1) Tracking, active search, monitoring of priority users, those at risk and with systemic problems, suspicions of COVID-19 and contacts, through Telemonitation; 2) Initial listening, individual or collective educational activities, through Teleorientation; 3) Discussion of clinical cases for the definition of the opportunity / need for operative procedures, matrix support, sharing, solution of doubts among professionals and between these and teaching and research institutions, by Teleconsulting, among others. In addition to a review of Teledentistry in the context of the pandemic, we conceptualized the terms used and possibilities offered to SUS professionals, in addition to specifying the possible protocols for recording these activities to provide safe data for their monitoring and evaluation. Besides, we bring a brief discussion with promising experiences, carried out in the pre- and trans-pandemic contexts, which can be important strategies for the resumption of oral health in the post-pandemic scenario.

Characterization of Dental Surgeons of Pernambuco State in the COVID-19 Pandemic Context: Preliminary Data

Abstract Objective: To present the results of preliminary research on the characterization of dental surgeons in the state of Pernambuco, during a pandemic of COVID-19. Material and Methods: This is a cross-sectional, descriptive, and exploratory study, whose population was composed of dental surgeons with active enrollment in the Regional Dentistry Council of Pernambuco. Data collection was performed using an electronic form and included characterization of professionals (gender, age, time since graduation, marital status, family income and field of work) and health status (vaccination schedule, presence of comorbidities, biosafety knowledge and testing for COVID-19). Preliminary data correspond to the first week of collection, which were analyzed from the frequency, proportions, and measures of central tendency distributions. Results: Of the 363 dental surgeons, for the field of work, 38.6% work in both the public and private sectors. Comorbidities related to the worsening of COVID-19 were identified in 35.0% of participants, 24.5% are not up to date with influenza and hepatitis vaccines, and 79.3% have not been tested for COVID-19. Regarding the biosafety instructions for COVID-19, 30.7% received no training. Conclusion: It is necessary to immunize dental surgeons to prevent immunological diseases and expansion of the testing capacity for COVID-19, especially for professionals belonging to the risk group. In addition to guaranteeing the offer of qualification courses on biosafety, which is essential for the safe resumption of activities.

Offer and Use of Oral Health in Primary Care Before and After the Beginning of the COVID-19 Pandemic in Brazil

Abstract Objective: To compare the offer and use of oral health services in primary care, before and after the beginning of the COVID-19 pandemic in Brazil. Material and Methods: An observational study with a cross-sectional ecological design, using data from the Health Information System for Primary Care. Data regarding the number of Oral Health Teams (OHT), Oral Health Coverage in Primary Care (OHC), number of First Programmatic Dental Consultations (FPDC), and number of visits due to dental abscess and toothache were collected. Data regarding the 26 Brazilian states and Federal District were collected, as consolidated of the first quarter (January to April) of 2019 and of 2020. The median of the difference (MD) and the percentage of variation (%V) were obtained for each variable and were compared by Wilcoxon test (α<0.05). Results: An increase in the number of OHT was observed in 25 states (MD=45; %V=6.13; p<0.001), whilst the OHC increased in 17 states (MD=1.01; %V=1.62; p=0.035) between the 2019 and 2020. We also verified a significant reduction in the number of FPDC (MD=- 42.806; %V=-38.70; p<0.001), as well as in the number of visits due to dental abscess (MD=-1.032; %V=-29.04; p=0.002) and due to toothache (MD=-14.445; %V=-32.68; p<0.001). Conclusion: Although an expansion of OHT and OHC between 2019 and 2020 was verified, the offer and use of oral health services in primary care has decreased due to the COVID-19 pandemic.

Financing national policy on oral health in Brazil in the context of the Unified Health System

This article discusses the model of oral health care implemented in the Unified Health System of Brazil in the last decade. This model was conceived as a sub-sector policy that, over the years, has sought to improve the quality of life of the Brazilian population. Through a chronological line, the study presents the National Policy on Oral Health as a counter-hegemonic patient care model for the dentistry practices existing in the country before this policy was implemented. The reorganization of the levels of oral health care, the creation of reference facilities for secondary and tertiary care, through Centers of Dental Specialties and Regional Dental Prosthesis Laboratories, and the differential funding and decentralized management of financial resources were able to expand the actions of oral health for more than 90 million inhabitants. The evolution shown after the deployment of the National Oral Health Policy, as of 2004, demonstrates the greater integration of oral health care under the Unified Health System and provides feedback information to help this policy to continue to be prioritized by the Federal Government and receive more support from the state and local levels in the coming years.

Associação de Indicadores de Produção Odontológica e de Condição Sócio-Sanitária na Atenção Básica de João Pessoa – PB / Association of Dental Production Indicators and of Social and Sanitary Conditions in Primary Health Care in João Pessoa – PB

Analisar a associação de indicadores de produçãoodontológica e de condição sócio-sanitária na Atenção Básicade João Pessoa-PB. Material e Métodos: Coletou-se, doscinco Distritos Sanitários (DS) de João Pessoa, os indicadoresde produção odontológica (Primeira Consulta OdontológicaProgramática – PCOP; Ação Coletiva Escovação DentalSupervisionada – ACES; Procedimentos OdontológicosBásicos Individuais – POI; e razão do número de Exodontiassobre POI - EXO/POI) e os indicadores de condições sóciosanitárias(tratamento e abastecimento de água, destino dolixo, esgoto, tipo de casa e alfabetização aos 15 anos). Asinformações foram coletadas do Sistema de InformaçõesAmbulatoriais (SIA) e do Sistema de Informação da AtençãoBásica (SIAB). Para testar a hipótese de que a condiçãosócio-sanitária influencia sobre os indicadores de produçãoodontológica, utilizou-se o teste estatístico de Kruskal-wallis.Resultados: O DS 3 recebeu os maiores escores para osindicadores sócio-sanitários; e o DS 4 os maiores escorespara produção odontológica. Não foi encontrada associaçãosignificante (p>0,05) entre a condição sócio-sanitária e aoferta de serviços odontológicos. Conclusão: Os indicadoressócio-sanitários não influenciam a oferta de atenção emsaúde bucal. Portanto, a hipótese testada foi consideradafalsa...

The aim was to analyze the association of dentalproduction indicators and of social and sanitary conditions inPrimary Health Care in João Pessoa - PB. Material andMethods: From the five sanitary districts (DS) of João Pessoa,were collected dental production indicators (First DentalConsultation Program - PCOP; Supervised ToothbrushCollective Action - ACES; Basic Individual Dental Procedures- POI, and quotient of the number of tooth extractions and POI- EXO / POI) and indicators of socio-sanitary conditions(treatment and supply of water, destination of garbage,sewage, house type and literacy at 15 years old). Informationwas collected from the Ambulatory Information System (SIA)and Primary Care Information System (SIAB). To test thehypothesis that the socio-sanitary conditions modify theindicators of dental production, it was used the Kruskalwallistest. Results: The DS 3 has received the highest scoresfor social and health indicators, and the DS 4 the highestscores of dental production. It has been found no significantassociation (p>0.05) between socio-sanitary conditions andprovision of dental services. Conclusions: The socialsanitaryindicators do not modify the supply of oral healthcare. Therefore, the hypothesis tested has been found to befalse...

Ameloblastoma: presentación de un caso clínico / Ameloblastoma: report of a clinical case

El ameloblastoma es un tumor benigno de origen odontogénico, localmente agresivo y recidivante. Afecta especialmente la región de molares inferiores, ángulo ascendente de la mandíbula y es encontrado en hombres y mujeres en la tercera década de la vida. El objetivo de este trabajo es presentar un caso clínico de ameloblastoma en un hombre de 42 años. El tratamiento quirúrgico y la rehabilitación incluyeron hemimandibulectomía, injerto de cresta ilíaca, implantes osteointegrados y prótesis, respectivamente. El paciente fue controlado clínica y radiográficamente durante ocho años, al cabo de los cuales no hubo manifestación de signos o síntomas que indicaran la recidiva

Prevalência de hemagioma na cavidade bucal em pacientes do hospital Napoleão Laureano - João / Prevalence of the oral cavity hemagioma in patients from the hospital Napoleão Laureano João Pessoa, Paraíba (Brazil)

Este estudo objetivou verificar a prevalência de hemangiomas localizados na cavidade bucal. A abordagem foi indutiva com procedimento descritivo e técnica de pesquisa documental indireta. O universo do estudo compreendeu todos os prontuários de pacientes (101), de ambos os gêneros, que buscaram atendimento no serviço de cirurgia de cabeça e pescoço do hospital Napoleão Laureano (HNL) João Pessoa/PB, foram submetidos à biópsia e apresentaram diagnóstico anátomo-patológico de hemangioma em cavidade bucal, no período de janeiro de 1996 a dezembro de 2000.Como amostra foram selecionados os prontuários daqueles pacientes (n=18, 17,8 por cento) que, além de serem submetidos à biopsia, receberam tratamento no HNL. Os resultados encontrados foram: a) houve maior prevalência no gênero masculino (10 casos; 55,55 por cento), na faixa etária de 3-12 anos (9 casos; 50,03 por cento) e na etnia branca (9 casos; 50,03 por cento região mais acometida (9 casos; 50,03 por cento mucosa labial (5 casos; 27,78 por cento); c) a hipótese diagnóstica inicial foi compatível em apenas 4 casos (22,23 por cento). De acordo com a metodologia empregada e a análise dos resultados encontrados, pode-se concluir que houve maior prevalência de hemangiomas em pacientes do gênero masculino, de etnia branca e faixas etária mais baixas, com maior ocorrência em língua. Houve expressiva discordância entre a hipótese diagnóstica e o resultado do exame anátomo-patológico