Percepção de adultos e idosos sobre os seus comportamentos e sua condição de saúde bucal segundo o seu nível de literacia em saúde / Perception of adults and elderly on your behaviors and your oral health condition according their level of health literacy

Resumo Introdução O nível da literacia em saúde pode ser um fator que influencia os comportamentos e a saúde dos indivíduos. Objetivo Analisar a percepção de adultos e idosos sobre os seus comportamentos e sua condição de saúde bucal segundo o seu nível de literacia em saúde (LS). Método O presente estudo qualitativo foi realizado com adultos e idosos que que participaram da 'Coorte de Saúde Bucal de Adultos de Piracicaba', sendo classificados conforme os três perfis de perda dentária seguintes: 1) nunca ter perdido dentes; 2) incidência de perda dentária ≥ 4 dentes; 3) edêntulo total e com nível de literacia em saúde alta e baixa de acordo com a variável LS dicotomizada a partir da mediana. Para a coleta dos dados, foi feita uma nova entrevista domiciliar gravada com uso de roteiro-guia e após a transcrição foi realizada a análise de conteúdo. Resultados Independente do nível de LS, os indivíduos identificaram fatores de risco e proteção determinantes para o processo saúde-doença bucal. No entanto, os entrevistados com baixa LS apresentaram uma maior propensão aos comportamentos de risco. Os fatores individuais foram preponderantes para o entendimento de sua condição bucal, seja pelo sentimento de descuido ou de responsabilidade pela falta de acesso aos serviços odontológicos, seja pelo aspecto socioeconômico ou geográfico. Conclusão Os indivíduos com alta LS apresentaram uma capacidade argumentativa e um entendimento maiores sobre os comportamentos saudáveis, como higiene bucal e uso regular do serviço odontológico, independente do tipo de serviço utilizado.

Abstract Background The level of health literacy can be a factor that influences the behaviors and health of individuals. Objective To analyze the perception of adults and the elderly on their behaviors and their oral health conditions according to their level of health literacy (HL). Method The qualitative study was carried out with adults and the elderly who participated in the "Piracicaba Adult Oral Health Cohort" and had been classified into three tooth loss profiles: 1) never having lost teeth; 2) incidence of tooth loss ≥ 4 teeth; 3) total toothlessness and the level of health literacy dichotomized in the median at high and low HL. There was a new home interview recorded using a script, and after transcription, content analysis was performed. Results The individuals, regardless of the HL level, identified risk and protective factors that were decisive in the oral health-disease process. However, individuals with low HL were more adept at risky behavior. The individual factors were preponderant for the understanding of his oral condition, either by the feeling of carelessness or by the feeling of responsibility for the lack of access to dental services, either by the socioeconomic or geographical aspect. Conclusion Individuals with high HL showed greater argumentative capacity and understanding of healthy behaviors, such as oral hygiene and regular use of dental services, regardless of the type of service used.

Functional dentition and associated factors: the evaluation of three indicators

Studying the different indicators of functional dentition classification can contribute to the understanding of the associated factors, and thus help in the definition of strategies associated with oral health care. This approach has been little explored in the literature, especially when considering the older age group. Aim:The aim of this study is to evaluate the factors associated with three distinct functional dentition classification. Methods: Cross-sectional exploratory study using secondary data from the Frailty in Older Brazilians (FIBRA) Project of 876 older adults living in Campinas, Brazil. The indicators of dental function assessed was number of natural teeth present, occluding pairs of teeth and the Eichner index, which were verified by trained dentists, following the World Health Organization criteria for epidemiological studies in oral health. The explanatory variable assessed was the self-perception of oral health-related quality of life measured by the Geriatric Oral Health Assessment Index (GOHAI) and its dimensions. It was also collected sociodemographic information such as age, gender, race/ethnicity, schooling, family income, smoking behavior and frailty status. The association was verified through Poisson regressions for number of teeth and pairs of teeth in occlusion and multinomial regression for the Eichner index, adjusted by sociodemographic and health variables. Results: Lower prevalence of participants with less than 21 teeth who negatively perceived GOHAI ́s pain and discomfort dimension and higher prevalence of having less teeth among the ones that negatively perceived GOHAI ́s physical and functional dimensions. No association was found between the perception of quality of life and occlusion pairs of teeth and the Eichner Index. Conclusion: Two out of three indicators assessed were associated with quality of life. Therefore, it is important to select sensitive indicators to be able to identify and better comprehend this relationship

Health literacy dimensions among public health service users with chronic diseases in Piracicaba, Brazil, 2019

Aim: This study analyzes factors associated with dimensions of health literacy (HL) functional, communicative and critical among public health service users with chronic non-communicable diseases. Methods: A cross-sectional analytical research was carried out in Piracicaba, São Paulo, Brazil, with adults and older adults attending Family Health Units (FHU). Data were collected by oral exam (CPOD and CPI) and a questionnaire on systemic conditions, sociodemographic factors, health behaviors and HLS (HLS-14). The outcomes consisted of functional, communicative, and critical HL dimensions dichotomized by median (high and low), which were analyzed by chi-square test (p<0.05) to find associations with the variables studied. Results: The study sample comprised 238 FHU users with 62.7 (± 10.55) mean age, of which 47.5% (n=113) showed high functional HL, 50.0% (n=119) high communicative HL, and 46.2% (n=110) high critical HL. High functional HL was associated with men (p<0.05). Functional and communicative HL were associated with having higher education (p<0.001 and p=0.018, respectively). High communicative and critical HL were associated with regular use of dental and medical services (p<0.05). Individuals with low functional HL were more likely to present poor tooth brushing (p=0.020). High HL (in all three dimensions) was associated with regular flossing and having more teeth (p<0.05). Conclusion: Functional, communicative and critical HL were associated with health behaviors and clinical outcomes, whereas the functional dimension was also associated with sociodemographic factors. HL dimensions allowed to differentiate health-related factors

Self-assessed masticatory function and frailty in Brazilian older adults: the FIBRA Study

ABSTRACT OBJETIVE To investigate the relationship between the masticatory function and the frailty of older people. METHODS Exploratory cross-sectional study using secondary data from the FIBRA Project on the frailty conditions of older people living in urban areas of six Brazilian municipalities, from 2008 to 2009. The population consisted of older adults aged 65 and over with no cognitive impairment. A single session identification questionnaire and the Mini-Mental State Examination (MMSE) were applied, followed by collecting sociodemographic data and data on the participants' self-assessment of masticatory function, general health, and oral health. RESULTS 2,341 older people (164 frail older adults), of whom 63.2% reported not having seen a dentist in the last year, and approximately 26% of them had three or more functional feeding problems. Older participants (OR = 2.88; 95%CI: 2.01-4.13), who are retired (OR = 2.31; 95%CI: 1.18-5.53), those who were depressed (OR = 2.31; 95%CI: 1.58-3.38), and those who self-assessed their general health as worse compared to others of the same age (OR = 3.91; 95%CI: 2.39-6.40) were at higher risk of frailty. Three or more problems related to the functional aspects of mastication were associated with a greater chance of frailty (OR = 2.06; 95%CI: 1.25-3.41). CONCLUSION This study found an association between masticatory function and a greater chance of frailty among the studied population.

Perda de função mastigatória e risco de fragilidade em idosos vivendo em domicílios familiares no Estado de São Paulo / Masticatory function loss and frailty risk in community-dwelling older people in the State of São Paulo

Resumo Objetivo Verificar se a perda de função mastigatória aumenta o risco de fragilidade em idosos vivendo em domicílios familiares no Estado de São Paulo. Métodos Foi adotado um delineamento de coorte prospectivo sobre a base de dados do estudo FIBRA (Fragilidade em Idosos Brasileiros), com linha de base realizada em 2008-2009 e seguimento em 2016-2018, transcorrendo em média 100,2 ± 9,2 meses. A variável desfecho foi a incidência de fragilidade, a variável de exposição foi a função mastigatória conforme a condição de edentulismo e autorrelato de dificuldade mastigatória. As variáveis de ajuste foram condições sociodemográficas, comportamentais e de saúde geral. Foi utilizado um modelo de regressão de Poisson, com variância robusta, estimando o risco relativo Resultados a incidência acumulada de fragilidade aos oito anos em média foi de 30 casos a cada 100 participantes edêntulos com dificuldade mastigatória, que apresentaram maior risco de desenvolver fragilidade (RR:1,75 IC 95% 1,09-2,81) do que os idosos dentados sem dificuldade mastigatória, independentemente de tabagismo (RR: 1,71 IC 95% 1,07-2,73) e de condição socioeconômica (RR: 1,72 IC 95% 1,13-2,62). Conclusão A perda de função mastigatória aumentou o risco de fragilidade em idosos.Futuras pesquisas deverão estudar se a reabilitação da função mastigatória contribui para diminuir esse risco.

Abstract Objective To verify if the loss of masticatory function increases the risk of frailty in community-dwelling older people in the state of São Paulo. Methods A prospective cohort design was adopted based on the FIBRA study database (Fragility in Brazilian Elderly), with a baseline performed in 2008-2009 and follow-up in 2016-2018, elapsed on average 100.2 ± 9.2 months. The outcome variable was the incidence of frailty. The exposure variable was masticatory function according to edentulism and self-reported chewing difficulty. Adjustment variables were sociodemographic, behavioral, and general health conditions. A Poisson regression model with robust variance was used to estimate the relative risk. Results the cumulative incidence of frailty over eight years was 30 cases per 100 edentulous participants with chewing difficulties, who had a higher risk of developing frailty (RR: 1.75 95% CI 1.09-2.81) than the dentate elderly without chewing difficulties, regardless of smoking (RR: 1.71 95% CI 1.07-2.73) and socioeconomic status (RR: 1.72 95% CI 1.13-2.62) Conclusion Loss of masticatory function increases the risk of frailty in older people. Future research should study whether the rehabilitation of oral function reduces this risk.

Effects of the intervention of the Multicenter Study IDEFICS on the prevalence of caries in Spanish children

Aim: To evaluate the effects of an intervention for the prevention of obesity on the prevalence of dental caries disease in Spanish children. Methods: Two cities participated intervention study nested in a cohort IDEFICS (Identification and prevention of dietary and lifestyle induced health effects in children and infants): Huesca, where there was a 2-year intervention, which encouraged less sugar consumption; and Zaragoza (control). The prevalence of caries was evaluated by examining the 1st permanent molars in the 7-11 age range, using the ICDAS (International Caries Detection and Assessment System). These teeth erupt at 6 years of age and at the baseline (2007-2008) were free of caries because they were not present in the oral cavity. As outcomes, white spots were selected, combining the ICDAS criteria 1 and 2, and untreated caries, combining criteria 4, 5 and 6. Their association with socioeconomic variables, BMI (Body Mass Index), frequency of sugar intake, sex and parents' perceptions of their children, was investigated. To do so, the chi-square test was applied (p<0.05). Results: The sample consisted of 281 children. The prevalence of white spots and untreated caries was higher in Huesca, despite the intervention. There was no association between the outcomes and the variables studied (p>0.05). Conclusion: The intervention for the prevention of obesity did not exert any association with the prevalence of caries in Spanish children

The role of health literacy as a factor associated with tooth loss / O papel da literacia em saúde como fator associado às perdas dentárias

ABSTRACT OBJECTIVE The objective was to analyze the role of health literacy (HL) as a factor associated with tooth loss among users of the Brazilian Health System with chronic non-communicable diseases. METHODS The cross-sectional analytical study was conducted with adult and elderly users chosen at ten Family Health Clinics in a draw in the town of Piracicaba, São Paulo State, Brazil. A questionnaire was applied with sociodemographic data (sex, age, skin color and education), behavioral data (brushing and flossing), determinants in health (type of dental health services and how often) and clinical data (pain). Mouth conditions were collected by intraoral examination of visible dental biofilm and community Pediodontal Index. The systemic clinical conditions (blood glucose, glycated hemoglobin and blood pressure) were extracted from the medical records. The explanatory variable was HL (low, medium and high), measured with the Health Literacy Scale (HLS-14). RESULTS The outcome was tooth loss measured by the index of decayed, missing and filled teeth. Logistic regression was performed using a conceptual model for HL (p < 0.05). For the 238 subjects, the mean age was 62.7 years (± 10.55). Tooth loss was associated with HL in regression models adjusted by type of dental service, dental frequency, and dental floss. In the final model, the factors associated with tooth loss are older age (OR = 1,12; 95%CI: 1,07-1,17), a lower education (OR = 3,43; 95%CI: 1,17-10,10), irregular use of dental floss (OR = 4,58; 95%CI: 1.75 in-7,31), irregular use of dental services (n = 2,60; 95% 1,32-5,12), periodontal pocket (> 4 mm) (n = 0,31; 95%CI: 0,01-0,08), having visible dental biofilm (OR = 7,23; 95%CI: 3,19-16,41) and a higher level of blood sugar (glucose) (n = 1,98; 95%CI: 1.00-3,92). CONCLUSIONS tooth loss was associated with HL when adjusted by health behaviors; when sociodemographic variables and clinical conditions were included, it was less significant. In the final model, behaviors, determinants in health and clinical conditions were risk indicators of tooth loss, showing the multifactorial nature of this phenomenon.

RESUMO OBJETIVO O objetivo foi analisar o papel da Literacia em Saúde (LS) como fator associado às perdas dentárias entre usuários do Sistema Único de Saúde com doenças crônicas não transmissíveis. MÉTODOS O estudo transversal e analítico foi conduzido com usuários adultos e idosos selecionados em dez Unidades de Saúde da Família sorteadas, em Piracicaba - SP, Brasil. Foi aplicado um questionário com dados sociodemográficos (sexo, idade, cor da pele e escolaridade), comportamentais (escovação e uso de fio dental), determinantes em saúde (tipo e frequência de uso de serviço de saúde médico e odontológico) e clínica (dor). As condições bucais foram coletadas por exame intrabucal do biofilme dental visível e Índice Pediodontal Comunitário. As condições clínicas sistêmicas (glicemia, hemoglobina glicada e pressóricas) foram extraídas dos prontuários. A variável explanatória foi a LS (baixa, média e alta), medida pelo Health Literacy Scale (HLS-14). RESULTADOS O desfecho foi à perda dentária medida pelo Índice de dentes permanentes cariados, perdidos e obturados. Foi realizada regressão logística com uso de um modelo conceitual para a LS (p < 0,05). Para os 238 indivíduos, a média de idade foi 62,7 anos (± 10,55). A perda dentária esteve associada à LS nos modelos de regressão ajustados por tipo de serviço odontológico, frequência odontológica e uso de fio dental. No modelo final, a perda dentária teve como fatores associados a maior idade (OR = 1,12; IC95% 1,07-1,17), menor escolaridade (OR = 3,43; IC95% 1,17-10,10), ao uso irregular de fio dental (OR = 4,58; IC95% 1,75-7,31), uso irregular do serviço odontológico (OR = 2,60; IC95% 1,32-5,12), bolsa periodontal (> 4mm) (OR = 0,31; IC95% 0,01-0,08), ter biofilme dental visível (OR = 7,23; IC95% 3,19-16,41) e maior índice de glicemia (OR = 1,98; IC95% 1,00-3,92). CONCLUSÕES A perda dentária esteve associada à LS quando ajustada por comportamentos em saúde, a partir da inclusão das variáveis sociodemográficas e condições clínicas ela perdeu a significância. No modelo final, comportamentos, determinantes em saúde e condições clínicas foram indicadores de risco da perda dentária, demonstrando a multifatorialidade envolvida neste fenômeno.

Botulinum toxin type A and acupuncture for masticatory myofascial pain: a randomized clinical trial

Abstract BoNT-A has been widely used for TMD therapy. However, the potential benefits compared to dry needling techniques are not clear. Objective this study aimed to compare the immediate effects of botulinum toxin type A (BoNT-A) injections and Acupuncture in myofascial temporomandibular disorders (TMD) patients. Methodology 54 women were divided into three groups (n=18). AC patients received four sessions of traditional acupuncture, being one session/week during 20-min. BoNT-A patients were bilaterally injected with 30U and 10U in masseter and anterior temporal muscles, respectively. Moreover, a control group received saline solution (SS) in the same muscles. Self-perceived pain was assessed by visual analog scale, while pressure pain threshold (PPT) was verified by a digital algometer. Electromyographic evaluations (EMG) of anterior temporal and masseter muscles were also measured. All variables were assessed before and 1-month after therapies. The mixed-design two-way repeated measures ANOVA and Tukey's post-hoc tests were used for analysis, considering a=0.05. Results Self-perceived pain decreased in all groups after one month of therapy (P<.001). BoNT-A was not better than AC in pain reduction (P=0.05), but both therapies were more effective in reducing pain than SS (P<0.05). BoNT-A was the only treatment able to improve PPT values (P<0.05); however, a severe decrease of EMG activity was also found in this group, which is considered an adverse effect. Conclusion after one month of follow-up, all therapies reduced the self-perceived pain in myofascial TMD patients, but only BoNT-A enhanced PPT yet decreased EMG.

Fatores associados à cárie dentária em adolescentes: um estudo transversal, estado de São Paulo, 2015 / Factores asociados con la caries dental en adolescentes: un estudio transversal, estado de São Paulo, Brasil, 2015 / Factors associated with dental caries in adolescents: a cross-sectional study, São Paulo State, Brazil, 2015

Resumo Objetivo: Analisar a associação entre prevalência e severidade da cárie e fatores demográficos e socioeconômicos, comportamental e de condições de saúde bucal em adolescentes. Métodos: Estudo transversal com dados secundários de 5.558 adolescentes (15 a 19 anos) examinados na Pesquisa Estadual de Saúde Bucal de São Paulo em 2015. As associações foram testadas pelo modelo de regressão binomial negativa inflado de zeros, considerando-se os pesos amostrais. estimaram-se as razões de prevalência (RP), razões de média (RM) e intervalos de confiança (IC). Resultados: A prevalência de cárie foi de 71,7%, maior no gênero feminino (RP=1,09 - IC95% 1,04;1,15), associada a atraso escolar (RP=1,11 - IC95% 1,03;1,18), cálculo dentário (RP=1,10 - IC95% 1,01;1,20) e não acesso à água fluoretada (RP=1,21 - IC95% 1,01;1,45). Conclusão: A identificação dos fatores associados à cárie pode instruir a programação dos serviços de saúde dirigidos ao controle da doença.

Resumen Objetivo: Analizar la asociación entre prevalencia y magnitud de la caries y factores demográficos, socioeconómicos, conductuales y de salud bucal en adolescentes. Métodos: Estudio transversal con datos secundarios de 5.558 adolescentes (15 a 19 años) examinados en la Encuesta de Salud Oral del Estado de São Paulo en 2015. Las asociaciones se probaron mediante el modelo de regresión binomial negativa inflado de ceros, considerando los pesos de la muestra. Se estimaron las razones de prevalencia (RP), razones medias (RM) e intervalos de confianza (IC). Resultados: La prevalencia de caries fue del 71,7% y mayor en las mujeres (PR=1,09 y IC95% 1,04;1,15), asociada a atraso escolar (PR=1.11 - IC95% 1,03;1,18), cálculo dental (PR=1,10 - IC95% 1,01;1,20) y sin acceso a agua fluorada (PR=1,21 - IC95% 1,01;1,45). Conclusión: La identificación de los factores asociados con la caries puede instruir la programación de servicios de salud destinados a controlar enfermedad.

Abstract Objective: To analyze association between prevalence and severity of dental caries and demographic, socioeconomic, behavioral and oral health status in adolescents. Methods: This was a cross-sectional study with secondary data on 5,558 adolescents examined in the São Paulo State Oral Health Survey in 2015. The zero-inflated negative binomial regression model was used, considering sample weights. Prevalence ratios (PR), ratios of mean (RM) and confidence intervals (CI) were estimated. Results: Caries prevalence was 71.7%, and was higher in females (PR=1.09 - 95%CI 1.04;1.15), associated with being behind at school (PR=1.11 - 95%CI 1.03;1.18), dental calculus (PR=1.10 - 95%CI 1.01;1.20) and no access to fluoridated water (PR=1.21 - 95%CI 1.01;1.45). Conclusion: Identification of factors associated with dental caries can instruct the programming of health services aimed at controlling the disease.

Self-rated general and oral health and associated factors in independently-living older individuals

Abstract The aim of this study was to verify the association between sociodemographic, general health, and oral health data with self-rated general health (SRGH) and self-rated oral health (SROH) in independent-living older Brazilians. This cross-sectional study was part of a larger study with older individuals living independently in the city of Campinas, Brazil - the "Rede FIBRA" Study (the Frailty in Brazilian Elderly Study). A random sample of 688 older individuals responded the SRGH and 673, the SROH. SRHG and SROH were both assessed using a single item. The questionnaire included sociodemographic, general, and oral health data. The mean age was 72.28 ± 5.4 years. The adjusted analysis revealed that the probability of rating general health as bad was higher for illiterate participants (PR: 1.77, 95%CI: 1.13-2.77) or with low educational level (PR: 1.76, 95%CI: 1.17-2.65), those with depressive symptoms (PR: 1.45, 95%CI:1.21-1.74), participants that self-reported food limitation due to problems with denture or lack of it (PR: 1.29, 95%CI: 1.05-1.56), and those with xerostomia (PR 1.40, 95%CI: 1.17-1.67). The probability of rating general health as bad was lower for participants that presented 0-2 chronic diseases (PR: 0.64, 95%CI: 0.53-0.78) and were pre-frail (PR: 0.76, 95%CI: 0.61-0.96). With regard to SROH, the probability of rating oral health as bad was higher for participants with natural teeth (PR:1.61, 95%CI: 1.24-2.08), that reported xerostomia (PR: 1.44, 95%CI: 1.13-1.84), and food limitation due to problems with denture or lack of it (PR: 1.43, 95%CI: 1.07-1,91), and lower for participants that reported having enough money to cover daily expenses (PR: 0.78, 95%CI: 0.61-0.99). Oral health data and income seem to be related to self-perceptions of general and oral health.

Spatial distribution of decayed and restored teeth in an adult population / Distribuição espacial de dentes cariados e restaurados numa população adulta

ABSTRACT Objective To analyze the spatial distribution of decayed and restored teeth in adults according to the Social Exclusion Index (SEI) and the proximity of public dental service. Methods: This ecological study used secondary data from an epidemiological survey of oral health and from the Piracicaba Research and Planning Institute (IPPLAP). The oral examinations of the DMFT index examined in households by a single examiner calibrated in 2011, by probability sampling, 248 adults (aged 20 to 64 years) representing the residents in Piracicaba-SP, Brazil. Data on social exclusion and health units with dental service were extracted from IPPLAP. We performed georeferencing of the census tracts selected by draw in the epidemiological survey and their respective districts, in addition to the health units with dental service in a radius of 500 m and 1000 m. Spearman's rank correlation coefficient was analyzed (p<0.05). Results: The smallest value of SEI, that is, the highest social exclusion, showed no correlation with decayed teeth (p=0.09), but had strong positive correlation with restored teeth (r=0.79; p<0.0001). Presence of public dental service in the vicinity of 500 m and 1,000 m showed no correlation, respectively, with the average number of decayed (p=0.07 and p=0.58) and restored (p=0.26 and p=0.56) teeth. Conclusion: Although the correlation between social exclusion and caries in adults was not observed, its case management, namely, the restored teeth, showed correlation with social inequalities. Presence of public dental service showed no correlation with components of caries experience evaluated in this study.

RESUMO Objetivo: Analisar a distribuição espacial dos dentes cariados e restaurados em adultos segundo o Índice de Exclusão Social (IEX) e a proximidade de serviço odontológico público. Metodologia: Este estudo ecológico utilizou-se de dados secundários de um levantamento epidemiológico de saúde bucal e do Instituto de Pesquisa e Planejamento de Piracicaba (IPPLAP). Os exames bucais do índice de dentes permanentes cariado perdidos e obturados (CPOD) examinou em domicílios por um único examinador calibrado em 2011, por amostragem probabilística, 248 adultos (20 a 64 anos) representativos dos residentes em Piracicaba-SP, Brasil. Os dados sobre exclusão social e as unidades de saúde com serviço odontológico foram extraídos do IPPLAP. Realizou-se o georreferenciamento dos setores censitários sorteados no levantamento epidemiológico e seus respectivos bairros, além das unidades de saúde com serviço odontológico em um raio de 500m e 1000m. Foi realizada a análise de correlação de Spearman (p<0.05). Resultados: O menor valor do IEX, ou seja, maior exclusão social, não apresentou correlação com dentes cariados (p=0,09), mas teve correlação positiva forte com dentes restaurados (r=0,79; p<0,0001). A presença de serviço odontológico público em proximidade de 500 e 1000m não apresentou correlação, respectivamente, com a média de dentes cariados (p=0,07 e p=0,58) e restaurados (p=0,26 e p=0,56). Conclusão: Apesar de não ser verificada correlação entre cárie e exclusão social em adultos, sua resolutividade, ou seja, os dentes restaurados apresentaram correlação com as desigualdades sociais. A presença de serviço odontológico público não apresentou correlação com os componentes de experiência de cárie avaliados nesse estudo.

Validity of self-report of oral conditions in older people

Aim: To verify if self-report is a valid instrument to study the clinical oral condition in older people without cognitive deficit. Methods: A Cross-sectional study was conducted with 647 older people from the community, without cognitive deficit, living in Campinas, Brazil. A self-report questionnaire assessing the presence or absence of teeth (edentulism) and use of complete denture was applied, identifying the location of the denture, whether in the upper and/or lower arch. In the same session oral clinical exams were performed, considered the gold standard. The self-report validation was performed by calculating sensitivity, specificity, predictive values, odds ratios and Kappa agreement. Results: There were high percentages of sensitivity (95­99%), specificity (84­97%), positive (81­97%) and negative (95­98%) predictive values, obtaining an elevated level of confidence and quality intrinsic value of self-report. Agreement with the clinical examination was excellent for all variables (greater than 0.80). The likelihood ratios showed compelling evidence that with self-report an edentulous individual (+LR 32), non-edentulous (-LR 0.06) and absence of complete denture (-LR 0.01) could be correctly identified, with moderate evidence to identify the presence and location of complete denture use (+LR 6.5 to 6.9). Conclusion: Self-report is a valid instrument to study the clinical oral condition in the older people of the community

Spatial analysis and climatic factors related to dengue in a small municipality of São Paulo, Brazil / Análise espacial e fatores climáticos relacionados à dengue, em município de pequeno porte de São Paulo, Brasil

Objective: to analyze the relationship of climatic variables, temperature and rainfall, - with dengue, in addition to identifying possible areas of greater spatial concentration of confirmed dengue cases. Methods: This is an ecological study with secondary data in the city of Ubirajara / SP. The confirmed cases of Dengue, assumed as an outcome, were obtained from the Aging and Notification Information System (SINAN) of the Ministry of Health; while the climatic data were used as independent variables and temperature and precipitation were provided by IPMet - Center of Meteorology of Bauru / SP, from 2007 to 2015. Pearson's correlation (r) was used for statistical analyzes. The addresses were geocoded and related to the digital cartoFigureic base of the municipality through the software QGIS and elaborated the thematic map through the kernel intensity estimator. Results: 187 cases of dengue were reported in the study period, with 119 cases (63.7%) occurring in 2015 with an incidence coefficient of 25.39 cases per 1,000 inhabitants. Mean annual temperature correlated positively with dengue and (r) (Pearson) cases = 0.6889, p = 0.0401 (α = Type I error) and ß = 0.6652 (Type II error). The Kernel map identified four areas of greatest concentration for dengue transmission. Conclusions: The relationship between temperature increase and dengue cases requires adequate responses from the institutions, with continuous monitoring of trends, construction of predictive models for the formulation of plans by using spatial analysis in the identification of the priority areas for actions that will be performed. (AU)

Objetivo: analisar a relação das variáveis climáticas, temperatura e precipitação pluviométrica, com a dengue, além de identificar possíveis áreas de maior concentração espacial de casos confirmados de dengue. Métodos: Trata-se de um estudo ecológico com dados secundários do município de Ubirajara/ SP. Os casos confirmados de Dengue, assumidos como desfecho, foram obtidos junto ao Sistema de Informação de Agravos e Notificações (SINAN) do Ministério da Saúde; enquanto os dados climáticos utilizados como variáveis independentes foram temperatura e precipitação, os quais foram fornecidos pelo Centro de Meteorologia de Bauru/ SP - IPMet, no período de 2007 a 2015. Utilizou- se a correlação Pearson (r) para as análises estatísticas. Os endereços foram geocodificados e relacionados com a base cartográfica digital do município, por meio do software QGIS. Foi elaborado o mapa temático segundo o estimador de intensidade de Kernel. Resultados: Foram notificados 187 casos de dengue no período do estudo; no entanto, somente em 2015 registraram-se 119 casos (63,7%), com um coeficiente de incidência de 25,39 casos por 1.000 habitantes. A temperatura média anual se correlacionou positivamente com os casos de dengue e r (Pearson) = 0,6889, p = 0,0401 (α = Erro tipo I) e ß = 0,6652 (Erro tipo II). O mapa de Kernel identificou quatro áreas de maior concentração para a transmissão da dengue. Conclusões: A relação do aumento da temperatura com os casos de dengue exige respostas adequadas das instituições, como o acompanhamento permanente de tendências, de construção de modelos preditivos e de formulação de planos que façam uso de análise espacial na identificação de áreas prioritárias para as ações que serão realizadas. (AU)

Sociodemographic factors associated with pregnant women's level of knowledge about oral health / Fatores sociodemográficos associados ao grau de conhecimento em saúde bucal de gestantes

ABSTRACT Objective To evaluate knowledge on oral health and associated sociodemographic factors in pregnant women. Methods A cross-sectional study with a sample of 195 pregnant women seen at the Primary Care Unit Paraisópolis I, in São Paulo (SP), Brazil. For statistical analysis, χ2 or Fisher's exact test and multiple logistic regression were used. A significance level of 5% was used in all analyses. Results Schooling level equal to or greater than 8 years and having one or two children were associated with an adequate knowledge about oral health. Conclusion Oral health promotion strategies during prenatal care should take into account sociodemographic aspects.

RESUMO Objetivo Avaliar o conhecimento em saúde bucal e os fatores sociodemográficos associados em gestantes. Métodos Estudo com delineamento transversal, com amostra de 195 gestantes atendidas na Unidade Básica de Saúde de Paraisópolis I, em São Paulo (SP). Para a análise estatística, utilizou-se teste χ2 ou teste exato de Fisher e a regressão logística múltipla. Assumiu-se um nível de significância de 5% para todas as análises. Resultados Escolaridade igual ou maior a 8 anos de estudo e presença de um a dois filhos estiveram associadas a conhecimento adequado sobre saúde bucal. Conclusão Estratégias de promoção de saúde bucal durante o pré-natal devem levar em consideração aspectos sociodemográficos.

Effectiveness of a preventive oral health program in preschool children

Aim: To evaluate the effectiveness of an educational preventive program in oral health on preschoolers. Methods: The final sample was 71 children in the test group and 48 in the control group. Intraoral exams were conducted for caries experience (dmf-s), white spot lesions (WSL) diagnosis, dental biofilm and treatment needs (before and after intervention- the interval was 18 months). Caregivers answered a questionnaire about socioeconomic data and health behavior. The educational preventive program consisted of supervised brushing, education in oral health, fluoride application and lectures to caregivers. Mann Whitney and Wilcoxon tests (p <0.05) were used to compare data between groups. Results: Mean caries experience was 0.94 (± 3.42) and 0.94 (± 2.87) in test and control groups, respectively. Baseline mean for dental biofilm was 4.95, and final mean was 0.21 in test group (p = 0.047). Conversely, the same variables were 4.11 and 0.84 in the control group (p = 0.047). The program was evaluated as very good (54.9% of caregivers), improvement of brushing was related by 62%, and more children went to the dentist (p <0.01). Conclusion: The educational preventive program seems to be effective for dental biofilm reduction, improved brushing and dental visits, being an important strategy for oral health maintenance in children

Fatores associados à prevalência e intensidade de odontalgia em crianças de municípios da região de campinas, são paulo / Factors associated with the prevalence and intensity of dental pain in children in the municipalities of the campinas region, são paulo

RESUMO Objetivo: Avaliar a prevalência e a intensidade de odontalgia em crianças segundo porte populacional do município, fatores associados e absenteísmo. Métodos: A amostra constituiu-se de crianças de 12 anos provenientes de escolas públicas e privadas, sorteadas em oito cidades da região de Campinas (SP). Foi aplicado um questionário com dados de odontalgia, demográficos, socioeconômicos bem como foi realizado exame clínico para avaliar a experiência de cárie. Ter dor foi o desfecho para análise de regressão logística e a intensidade da dor para a regressão log-binomial negativa. Adotou-se nível de significância de 5%. Resultados: A amostra foi constituída de 1.233 crianças, sendo que 16,7% relataram dor nos últimos seis meses. A odontalgia foi causa de 46,4% do absenteísmo escolar nesse período. A prevalência de dor foi menor entre os de alta renda familiar (p=0,023) e maior entre não brancos (p=0,027). A intensidade da dor foi menor nos municípios de médio (p=0,02) e pequeno porte (p=0,004) e maior nas crianças cujos pais tinham menor nível de escolaridade (p=0,003), que procuraram o dentista por dor (p=0,04) e que apresentavam cárie não tratada (p=0,04). Conclusões: A prevalência e a intensidade da dor de dente em crianças de 12 anos estão relacionadas com aspectos socioeconômicos da família, como baixa renda e menor escolaridade dos pais, e causam impacto na atividade diária por meio do absenteísmo escolar. A intensidade foi menor em municípios de médio e pequeno porte. Estratégias de promoção de saúde bucal nessa faixa etária devem ser estimuladas para evitar a odontalgia.

ABSTRACT Objective: The aim of this study was to evaluate the prevalence and intensity of dental pain in children according to size of municipality, associated factors and absenteeism. Methods: The sample consisted of children aged 12 years old from public and private schools drawn from eight cities in the region of Campinas (SP). A questionnaire was applied to obtain dental pain, demographic, socioeconomic data, and a clinical examination was carried out to evaluate the experience of having a cavity. The outcome for the logistic regression analysis was having pain and the outcome for the negative log-binomial regression was the intensity of pain. The significance level was 5%. Results: The sample consisted of 1,233 children, and 16.7% reported pain in the last six months. Dental pain was the cause of 46.4% of school absenteeism during this period. The prevalence of pain was lower among households with high income (p=0.023) and higher among nonwhites (p=0.027). Pain intensity was lower in medium-sized cities (p=0.02) and small cities (p=0.004), and higher in children whose parents had a lower educational level (p=0.003), children who sought out a dentist for the pain (p=0.04) and who had untreated cavities (p=0.04). Conclusions: The prevalence and intensity of dental pain in children aged under 12 are related to socioeconomic aspects of the family, such as low-income and parents with a low level of education, which impact daily activities as seen through school absenteeism. Pain intensity was lower in medium and small cities. Oral health promotion strategies in this age group should be encouraged to avoid dental pain.

Condição de saúde bucal e motivos para extração dentária entre uma população de adultos (20-64 anos) / Oral health condition and reasons for tooth extraction among an adult population (20-64 years old)

Resumo O presente estudo caracterizou a condição de saúde bucal e os principais motivos autorrelatados da extração dentária em uma população de adultos. Estudo transversal que examinou 248 adultos de 20-64 anos, representativos da população de Piracicaba (SP). O exame bucal domiciliar utilizou os índices CPOD, CPI, uso e necessidade de prótese dentária segundo critérios da OMS e presença de biofilme visível. Foram coletados dados demográficos, socioeconômicos e motivos da extração dentária por meio de questionário. A análise descritiva foi estratificada pela idade em 20-44 e 45-64 anos. O CPOD médio foi 20,37, P = 3,34 nos adultos jovens e P = 13,41 nos mais velhos. Bolsa periodontal (CPI ≥ 3) foi encontrada em 20,5% dos adultos jovens e 53,0% dos mais velhos. Enquanto 38,8% usavam prótese superior, 46,7% necessitavam de prótese inferior. A dor foi o motivo autorrelatado mais prevalente para realização da extração dentária, sendo esta escolha principalmente pela falta de outra opção de tratamento e no serviço privado. Conclui-se que os adultos jovens (20-44 anos) apresentaram menos dentes perdidos e doença periodontal, uso e necessidade de prótese. Dor e falta de opção de outros tratamentos foram os principais motivos autorrelatados para realização das extrações dentárias.

Abstract The study characterized the oral health condition and main self-reported reasons for tooth extraction in an adult population. The cross-sectional study examined 248 adults aged 20-64 years, representative of the population of Piracicaba, São Paulo, Brazil. The oral examination conducted in households used the DMFT and CPI indexes, use and necessity of prosthodontics according to the WHO criteria and the presence of visible biofilm. Demographic and socioeconomic data were collected along with reasons for tooth extraction through a questionnaire. Descriptive analysis was stratified by age in groups: 20-44 and 45-64 years old. The average DMFT was 20.37 (EP = 0.50), P = 3.34 (EP = 0.33) for young adults and P = 13.41 (EP = 1.45) for the older adults. Gingival pockets (CPI ≥ 3) were found on 20.5% of young adults and 53.0% of the older ones. While 38.8% used upper prosthesis, 46.7% needed lower prosthesis. Pain was the most prevalent self-reported reason for tooth extraction (37.5%), being this choice primarily because of lack of another treatment option (52%) and done in the private sector (47.2%). We concluded that young adults (20-44 years old) showed less missing teeth, periodontal diseases, and need for prosthetic use. Pain and lack of options of other treatments were the main self-reported reasons for performing tooth extractions.

Mortality for oral Cancer in Minas Gerais, Brazil, from 1996 to 2012 / Mortalidade por Câncer de boca em Minas Gerais, Brazil, de 1996 a 2012 / La mortalidad en Cáncer de boca en Minas Gerais, Brasil, 1996 a 2012

Aim: To investigate the spatial-temporal distribution of mortality from oral cancer in Minas Gerais between 1996 and 2012. Methods: The analysis of the growth trend rates of the series was made by Moving Average. Results: In the period there were 8.675 deaths from mouth cancer and these were identified in all the regions of the state. Being, 6,974 (80,4%) men and 1,701 (19,6%) women. Regarding the crude rate, we observed a tendency of growing of mortality from this cancer type. This phenomenon was also observed when executed the weighting by sex, especially for males and over 60 years old. Was rejected the null hypothesis of stationary of mortality series for oral cancer in Minas Gerais during the period. Conclusion: Moving Average weighted by age and gender allowed to observe an increase in the mortality rate in all age groups and for both sexes especially men and older than 60 years.

Objetivo: Investigar a distribuição espaço-temporal da taxa de mortalidade por câncer de boca do estado de Minas Gerais entre 1996 e 2012. Métodos: A Média Móvel foi utilizada para analisar a tendência de crescimento da taxa. Resultados: No período estudado ocorreram 8.675 óbitos por câncer de boca e estes foram identificados em todas as microrregiões do estado. Sendo, 6.974 (80,4%) homens e 1.701(19,6%) mulheres. Houve tendência de crescimento da taxa bruta de mortalidade por este tipo de câncer. Este fenômeno também foi observado quando executado a ponderação por sexo, principalmente para o sexo masculino e indivíduos acima dos 60 anos. Foi rejeitada hipótese de nulidade de estacionariedade da mortalidade por câncer de boca em Minas Gerais no período estudado com elevação da taxa de 2,22 em 1996 para 3,87 em 2012. Conclusão: Observou-se o crescimento da taxa nas faixas etárias estudadas, em homens e acima de 60 anos.

Objetivo: Investigar la distribución espacial y temporal de la mortalidad por cáncer oral en el estado de Minas Gerais entre 1996 y 2012. Métodos: El promedio móvil se utilizó para analizar la tendencia de la tasa de crecimiento. Resultados: En el período hubo 8.675 muertes por cáncer de boca y éstos fueron identificados en todas las regiones del estado. Y, 6.974 (80,6%) eran hombres y 1.701 (19,6%) mujeres. Con respecto a la tasa bruta, se observa una tendencia creciente en la mortalidad por este tipo de cáncer y cuando se ejecuta la ponderación por sexo, especialmente para los varones y más de 60. Rechazó la hipótesis nula de estacionariedad de la mortalidad por cáncer oral en Minas Gerais durante el período. Conclusión: Promedio ponderado por edad y sexo Mobile ha observado tasa de crecimiento en los grupos de edad y en los hombres y por encima de 60 años.

Spatial distribuition of tooth loss in a population of adults / Distribuição espacial das perdas dentárias em uma população de adultos

ABSTRACT Introduction: Although there has been an improvement in the oral health status of the population, tooth loss still aggravates the oral health of adults and is a matter of great relevance to dentistry. Aim: To determine the spatial distribution of tooth loss in adults and correlate this with the Social Exclusion Index and proximity to public dental services. Material and Method: This ecological study was based on epidemiological data of adults from Piracicaba municipality and from the Piracicaba Research and Planning Institute (IPPLAP). Data on dental evaluations were extracted from the Piracicaba epidemiological survey, which was a cross-sectional study with probabilistic sampling of 248 adults aged 20-64 years, representative of adults living in Piracicaba, Brazil. Oral examinations of the DMFT index were in accordance with the World Health Organization codes and criteria and were performed by a single examiner calibrated for this purpose. Data on social exclusion and the municipal health units that have dental services were extracted from IPPLAP. Georeferencing was performed of census tracts selected by draw, and the city health facilities that have dental services. For Spearman correlation analysis (p <0.05), we used the mean value of teeth lost per district, the Social Exclusion Index (IEX), and proximity to public dental service categorized according to radius: <500m, between 500-1000m, and >1000m the census tract. Result: There was a correlation between tooth loss and higher IEX, and r=−0.51 (p=0.01), but no correlation with proximity to public dental services (p=0.42). Conclusion: Tooth loss in adults was distributed according to social exclusion, however, it was unrelated to proximity to the public dental services.

RESUMO Introdução: Embora haja uma melhoria na condição de saúde bucal da população, as perdas dentárias ainda constituem um agravo à saúde bucal de adultos e é um assunto de grande relevância para Odontologia. Objetivo: Verificar a distribuição espacial das perdas dentárias em adultos e correlacionar com o Índice de Exclusão Social e a proximidade de serviço odontológico público. Material e Método: Este estudo ecológico utilizou-se de dados de um levantamento epidemiológico de adultos no município de Piracicaba e do Instituto de Pesquisa e Planejamento de Piracicaba (IPPLAP). Os dados sobre as perdas dentárias foram extraídos do levantamento epidemiológico de Piracicaba, que trata-se de um estudo transversal com amostragem probabilística de 248 adultos com idade entre 20 e 64 anos, representativos dos adultos residentes em Piracicaba-SP, Brasil. Os exames bucais do índice CPO-D seguiram os códigos e critérios da Organização Mundial da Saúde e foram realizados em domicílios por um único examinador calibrado para esta finalidade. Os dados sobre a exclusão social e unidades de saúde com serviço odontológico do município foram extraídos do IPPLAP. Foi realizado o georreferenciamento dos setores censitários sorteados e as unidades de saúde com serviço odontológico do município. Para análise de correlação de Spearman (p<0,05), utilizou-se a média de dentes perdidos por bairro, o Índice de Exclusão Social (IEX) e a proximidade de serviço odontológico público categorizados em raio de: <500m, entre 500-1000m e >1000m do setor censitário. Resultado: Houve correlação entre a perda dentária e o maior IEX, sendo r = -0,51 (p=0,01), mas não houve correlação com a proximidade de serviço odontológico público (p=0,42). Conclusão: A perda dentária em adultos distribuiu-se de acordo com a exclusão social, no entanto, sem relação com a proximidade do serviço público odontológico.

Relação entre classificações de risco utilizadas para organização da demanda em saúde bucal em município de pequeno porte de São Paulo, Brasil / Relationship between risk classifications used to organize the demand for oral health in a small city of São Paulo, Brazil

Resumo As Equipes de Saúde Bucal podem trabalhar tanto com informações das populações relacionadas ao contexto familiar como epidemiológicas individuais, através de classificações de risco pensando em equidade e organização do serviço. O propósito do estudo foi avaliar a associação entre ferramentas que classificam o risco familiar e o individual. O grupo de estudo consistiu de escolares das faixas etárias de 5-6 anos e de 11-12 anos classificados para cárie e seus pais para doença periodontal e ambos para o risco familiar. Houve associação entre a classificação de risco para cárie nos escolares (n = 128) com a familiar, com Coef C = 0,338 e p = 0,01, indicando que quanto maior o risco familiar há tendência de maior risco de cárie. Da mesma forma, a associação entre a classificação de risco para doença periodontal nos pais, com a classificação de risco familiar, com Coef C = 0,5503 e p = 0,03, indicou que, quanto maior o risco familiar há tendência de maior risco de doença periodontal. Pode-se concluir que a utilização da ferramenta de classificação de risco familiar está indicada, como possibilidade de ser ordenadora das ações do serviço odontológico, organizando sua demanda com maior equidade, nesta porta de acesso.

Abstract Oral health teams can work with both information of the people related to the family context as individual epidemiological through risk ratings, considering equity and service organization. The purpose of our study was to evaluate the association between tools that classify individual and family risk. The study group consisted of students from the age group of 5-6 years and 11-12 years who were classified regarding risk of caries and whether their parents had periodontal disease, in addition to the family risk. There was an association between the risk rating for decay in children (n = 128) and family risk classification with Coef C = 0.338 and p = 0.01, indicating that the higher the family’s risk, the higher the risk of caries. Similarly, the association between the risk classification for periodontal disease in parents and family risk classification with Coef C = 0.5503 and p = 0.03 indicated that the higher the family risk, the higher the risk of periodontal disease. It can be concluded that the use of family risk rating tool is indicated as a possibility of ordering actions of the dental service, organizing their demand with greater equity, in this access door.