Occurrence of dental emergency events in Primary Health Care services

Abstract The aim of this study was to describe the occurrence of dental emergency and its association with individual factors and primary health care services. A follow-up study was conducted with data extracted from an exploratory study about the classification of dental care needs over time according to a care framework. There were included 1831 patients of five services. The outcome was the occurrence of dental emergency analyzed according to sex, age, skin color, service and maximum waiting time for dental care. A multivariate analysis with Poisson regression was used to estimate weighted prevalence ratio (PR) with 95% Confidence Intervals (CI) and survival analysis was conducted. The prevalence of dental emergency was 12.6%, varying according to age (13-19: PRa =1.79 (95%CI: 1.0-3.21); 20-65:PRa = 2.71 (95%CI: 1.73-4.26); Over 65: PRa = 2.51 (95%CI: 1.41-4.46)) and Primary Health Care service (FHS 2: PRa = 2.20 (95%CI: 1.37-3.53),FHS 3: PRa = 1.43 (95%CI: 0.90-2.27); FHS 4: PRa = 3.25 (95%CI: 2.15-4.92),FHS 5: PRa = 2.49 (95%CI: 1.56-3.97)) For 231 cases classified as emergency, the failure rate was 7.4%. For 214 cases of emergency, the non-continuity after appointment rate was 53.7%. The incidence of dental emergency was 8.3% and recurrence was 7.2%. Considering all 262 emergency cases attended, the resolution rate was 93.5% and most cases (n = 252, 96.1%) received care within one day. The results point to high effectiveness in emergency dental care within Primary Health Care services. There are indications of the need for improvements in retention and continuity of care.

A Framework for Equity Access to Primary Dental Care / Equidade de Acesso à Atenção Básica em Saúde Bucal

Abstract The objective of this study was to demonstrate face validity with a novel resource allocation framework designed to maximize equity into dental booking systems. The study was carried out in 2014. Eleven experts in primary dental care practice in Southern Brazil participated, using a three-round consensus group technique. First, the experts reached consensus on the items to be included in a 5-level diagnostic scale. They identified 21 clinical conditions and categorized them according to the oral health intervention required. Then, they described workload and activity standards for dental staff to carry out health promotion, oral disease prevention, dental treatment, dental rehabilitation, and urgent dental care. Finally, they agreed upon a set of wait times for primary dental care, establishing maximum waits from 2 to 365 days, according to the diagnostic classification. The framework demonstrated potential ability to promote more equitable access to primary dental services, since equal diagnostic classifications share the same waiting times for the dental care they require.

Resumo O objetivo do estudo foi demonstrar validade de face com uma nova matriz destinada a maximizar a equidade nos sistemas de agendamento odontológico. O estudo foi realizado em 2014, no qual participaram 11 dentistas com experiência de trabalho na rede básica de saúde da região sul do Brasil, utilizando a técnica de grupo de consenso em três rodadas de discussão. Primeiro, os participantes chegaram ao consenso quanto aos itens que deveriam estar presentes em uma escala de classificação diagnóstica de 5 níveis. Identificaram 21 condições clínicas de saúde bucal e as categorizaram conforme a intervenção necessária. A seguir, os participantes descreveram as cargas de trabalho e os padrões de atividade recomendados para a equipe odontológica realizar promoção da saúde, prevenção de doenças bucais, tratamento odontológico, reabilitação dentária, e atendimento odontológico de urgência. Por último, os dentistas chegaram ao consenso sobre tempos máximos de espera para atendimento odontológico na rede básica, estabelecendo prazos de 2 até 365 dias conforme a classificação diagnóstica atribuída. Este estudo demonstrou o potencial da matriz de alocação de recursos para promover acesso mais equitativo aos serviços odontológicos da rede básica, uma vez que classificações diagnósticas iguais compartilham os mesmos prazos de espera para o atendimento odontológico requerido.

The Effects of an Educational Intervention on the Early Management of Oral Lesions in the Umgungundlovu District in Kwazulu-Natal

Oral lesions that are associated with human immunodeficiency virus (HIV) infection are often the first clinical signs of an underlying infection. This study aimed to test primary healthcare (PHC) nurses' knowledge and practices before and after an educational intervention on the detection and management of oral diseases; and in particular; those associated with HIV infection. A cross-sectional study was conducted among PHC nurses who were employed in a range of clinical settings within the public sector (hospitals; clinics and nurse training colleges) in urban and rural areas in the uMgungundlovu Health District of KwaZulu-Natal. The convenience sample comprised 121 nurses who completed a self-administered questionnaire; undertook pre-education testing; were provided with educational material and underwent post-education testing. The obtained results showed that most nurses (90) had received little or no undergraduate or postgraduate training in the examination; diagnosis or treatment of oral lesions. Analysis of the pre-education test results that pertained to the identification of a number of oral lesions revealed a mean correct response rate of 38.5. Post-education results revealed a statistically significant (p-value .0001) (24) improvement to 62.4. The provision of a basic education intervention can have significant effects on knowledge; treatment and referral patterns; and can lead to early diagnosis; treatment and improved quality of life for persons who are infected with HIV

Oral Lesions in HIV-Infected Patients; Before and After Antiretroviral Treatment

Oral lesions cause considerable morbidity in HIV-infected patients. Antiretroviral therapy (ART) reconstitutes the immune system and reduces the incidence of opportunistic infections and malignan-cies. The aim of the present study was to determine the prevalence and range of oral lesions in patients before and after starting ART in Harare; Zimbabwe. A longitudinal; prospective study of oral lesions presenting in HIV-infected patients at baseline and three and six months after the initiation of ART was conducted. The study was undertaken at three hospitals in Harare. Two hundred and ten patients were enrolled; 96 (46) and 49 (23) patients presented for follow-up at three and six months; respectively. Two-thirds of the patients who completed follow-up were female; median age was 36 years. At six months of ART; the overall prevalence of oral lesions declined significantly (p 0.05). Oral candidiasis was the most common finding and showed the most significant reduction on ART. In contrast; the incidence of facial warts increased from baseline to three and six months. ART was effective in reducing the overall prevalence of oral lesions in HIV-infected patients; although incidence was variable depending on the type of lesion. Unmasking immune reconstitution inflammatory syndrome to human papillomavirus (HPV) is the likely cause for the increase in facial warts

Dog Bites to the Head; Neck and Face in Children

Dog bites are a poorly understood and complex public health problem. Children are most frequently the victims of dog bites and the face is often the favoured target. A review of dog bite wounds in small children presenting to the Red Cross War Memorial Children's Hospital was carried out over a period of 13.5 years (1991-2004). One thousand eight hundred and seventy-one dog bite wounds were admitted from a total of 125;677 patients treated. From 1;871 patients presenting with dog bite injuries; we identified 596 children who sustained injuries to the head; face or neck. Dog bites to the head; face or neck were responsible for 0.5 of all trauma unit presentations and 32 of all dog bite injuries. The mean age of the children was 5.1 years. Male children accounted for 68 of the patients. The peak incidence was noted in children aged 2 to 4 years old. One hundred and seventy-two (29) bites occurred between the summer months of December and February. Two hundred and forty-nine (42) patients presented to hospital between the hours of 12:00 and 18:00 hours and 275 (46) children presented between 18:00 and 0:00 hours. A large proportion of all attacks occurred either inside or outside the victim's own home and at the home of friends or family. Superficial injuries were treated with wound cleaning; suturing and dressing. There were no fatalities. Dog bites are relatively common in small children; but do not represent a major cause of morbidity and mortality