Oral manifestations and injuries related to covid- 19: an experience report on the role of hospital dentistry / Manifestações orais e lesões relacionadas à covid-19: um relatório de experiência sobre o papel da odontologia hospitalar / Manifestaciones orales y lesiones relacionadas con covid- 19: un informe de experiencia sobre el papel de la odontología hospitalaria

SARS-COV-2 is transmitted among human beings by saliva droplets that come in direct contact with the oral cavity, nose, and eyes. Since the mouth is one of the anatomical sites primarily contaminated, oral manifestations have also been reported beyond the serious consequences inherent to progressive respiratory failure. This study aimed to identify oral manifestations possibly related to the infection by COVID-19 in hospitalized patients. A prospective study was carried out with patients diagnosed with COVID-19 in the period between March and June 2021, admitted to the Moderate COVID-19 Care Unit of the Hans Dieter Schmidt Regional Hospital, by applying a form and performing a clinical exam of the oral cavity. Out of all patients (n=45), 33.3% reported both olfactory (anosmia) and taste dysfunction (dysgeusia), with an average duration of 5.9 ±3.0 days. Regarding other oral manifestations evaluated, two patients reported dry and burning mouth and one patient reported a change in taste associated with plaque-like changes in the tongue. No patients presented ulcers or other lesions in the oral cavity. Olfactory and taste dysfunction were symptoms recognized of the novel coronavirus disease (COVID-19). However, the association with other oral manifestations is still controversy. Unfortunately, dentistry professionals are still not part of most teams in the hospital environment, mostly because of the lack of prioritization of dental care. Working with a multidisciplinary team may avoid possible systemic complications due to poor dental care.

Sars-COV-2 é transmitida entre os seres humanos por gotículas de saliva que entram em contato direto com a cavidade oral, nariz e olhos. Uma vez que a boca é um dos sítios anatômicos principalmente contaminados, as manifestações orais também foram relatadas para além das graves consequências inerentes à insuficiência respiratória progressiva. Este estudo teve como objetivo identificar manifestações orais possivelmente relacionadas à infecção por Covid-19 em pacientes hospitalizados. Foi realizado um estudo prospetivo com pacientes diagnosticados com Covid-19 no período entre março e junho de 2021, internados na Unidade de Atendimento Moderado contra a Covid-19 do Hospital Regional Hans Dieter Schmidt, aplicando um formulário e realizando um exame clínico da cavidade oral. De todos os pacientes (n=45), 33,3% relataram disfunção olfativa (anosmia) e gustativa (disgeusia), com duração média de 5,9 ±3,0 dias. Em relação a outras manifestações orais avaliadas, dois pacientes relataram boca seca e ardente e um paciente relatou alteração no paladar associada a alterações semelhantes a placas na língua. Nenhum paciente apresentou úlceras ou outras lesões na cavidade oral. Disfunção olfativa e gustativa foram sintomas reconhecidos do novo coronavírus (Covid-19). No entanto, a associação com outras manifestações orais ainda é controversa. Infelizmente, os profissionais de odontologia ainda não fazem parte da maioria das equipes do ambiente hospitalar, principalmente por causa da falta de priorização dos cuidados odontológicos. Trabalhar com uma equipe multidisciplinar pode evitar possíveis complicações sistêmicas devido a cuidados odontológicos deficientes.

SARS-COV-2 se transmite entre los seres humanos por las gotitas de saliva que entran en contacto directo con la cavidad oral, la nariz y los ojos. Dado que la boca es uno de los sitios anatómicos principalmente contaminados, también se han informado manifestaciones orales más allá de las consecuencias graves inherentes a la insuficiencia respiratoria progresiva. El objetivo de este estudio fue identificar las manifestaciones bucales posiblemente relacionadas con la infección por COVID-19 en pacientes hospitalizados. Se realizó un estudio prospectivo con pacientes diagnosticados de COVID-19 en el periodo comprendido entre marzo y junio de 2021, ingresados en la Unidad de Cuidados Moderados de COVID-19 del Hospital Regional Hans Dieter Schmidt, mediante la aplicación de un formulario y la realización de un examen clínico de la cavidad oral. De todos los pacientes (n=45), el 33,3% notificó tanto disfunción olfativa (anosmia) como gustativa (disgeusia), con una duración media de 5,9 ±3,0 días. En cuanto a las demás manifestaciones orales evaluadas, dos pacientes notificaron sequedad y ardor de boca y un paciente notificó un cambio en el gusto asociado a cambios en la lengua en forma de placa. Ningún paciente presentó úlceras u otras lesiones en la cavidad oral. La disfunción olfativa y gustativa fueron síntomas reconocidos de la nueva enfermedad por coronavirus (COVID-19). Sin embargo, la asociación con otras manifestaciones orales es aún controvertida. Desafortunadamente, los profesionales de la odontología todavía no son parte de la mayoría de los equipos en el entorno hospitalario, principalmente debido a la falta de priorización de la atención odontológica. Trabajar con un equipo multidisciplinario puede evitar posibles complicaciones sistémicas debido a la mala atención dental.

Severe oral mucositis relating to pain and worse oral condition among patients with solid tumors undergoing treatment with FOLFIRI and 5-FU: a retrospective study

ABSTRACT BACKGROUND: There is a need for studies that correlate the severity of oral mucositis (OM) with chemotherapy protocols, transient myelosuppression and oral health. OBJECTIVE: To analyze the severity of OM among individuals with solid tumors during hospitalization and its correlation with the type of chemotherapy, myelosuppression and oral health condition. DESIGN AND SETTING: Retrospective study at a public hospital in Bauru, state of São Paulo, Brazil, that is a regional referral center. METHODS: Individuals diagnosed with solid malignant tumors who received chemotherapy during hospitalization for completion of the antineoplastic treatment cycle or who presented complications resulting from this were assessed. RESULTS: Twenty-eight individuals (24.3%) manifested some degree of OM. The most prevalent degrees of OM according to the World Health Organization (WHO) and modified WHO classification were grades 2 (11.3%) and 5 (4.3%), respectively. It was observed that the higher the OM-WHO (P < 0.001; r = 0.306) and modified OM-WHO (P < 0.001; r = 0.295) classifications were, the greater the oral pain reported by the individuals was. Presence of mucositis in the upper lip and buccal mucosa contributed to increased severity of OM and worsening of swallowing during hospitalization. Thus, severe OM was associated with use of the FOLFIRI protocol (folinic acid, fluorouracil and irinotecan). CONCLUSION: Individuals with tumors who presented severe OM had greater severity of oral pain and worse oral health. Use of the FOLFIRI protocol was associated with higher prevalence of severe OM, while use of 5-fluorouracil (5-FU) was correlated with worse oral condition.

Los aerosoles en Estomatología, incremento del riesgo de contraer el virus del SARS-CoV-2

RESUMEN Introducción: Los aerosoles en Estomatología constituyen un factor muy importante a tener en cuenta, pues estos facilitan con la dispersión de gotas minúsculas la trasmisión bacteriana a los trabajadores sanitarios y al medio ambiente del consultorio. Ante la presencia de la pandemia de la COVID-19, es un peligro que representa para la vida humana. Objetivo: Realizar una recopilación de información que argumente el riesgo de la transmisión del virus SARS-CoV-2 mediante el uso de aerosoles en la atención estomatológica y las medidas precisas adicionales a tener en cuenta para la prevención del contagio del personal de salud de esta área. Método: Se realizó un estudio en la Clínica Estomatológica Provincial Docente "Mártires del Moncada", de Santiago de Cuba, en el período comprendido de enero a septiembre de 2020, consistente en una revisión bibliográfica. La búsqueda se realizó en las bases de datos bibliográficos Pubmed, Medline, Science Direct, SciELO, y el buscador Google Académico, sobre la importancia de los aerosoles generados en la práctica estomatológica con relación a la actual pandemia. Resultados: La información encontrada, expresó las normas, medidas, criterios clínicos, precauciones y recomendaciones relacionados con los aerosoles en el consultorio estomatológico. Conclusiones: Además de las precauciones estándares, es imprescindible evitar el uso de instrumentos y dispositivos que generen aerosoles, ya que incrementan el riesgo de contraer el virus del SARS-CoV-2, no retirar los medios de protección en el espacio del consultorio, la necesidad de que los trabajadores dominen el conocimiento de todas las medidas, entre otras.

ABSTRACT Introduction: The use of aerosols in dental clinics represents a very important risk factor to be in focus as they could resulting in bacterial transmission to healthcare workers and entity environment through the dispersion of tiny droplets. Its use, in the presence of COVID-19 pandemic, represents a danger to human life. Objective: To gather essential information that argue the risk of SARS-CoV-2 related infection when using aerosols in dental care clinics, as well as the additional measures taken into account for preventing infection of health personnel. Method: It was conducted a bibliographic review at the Clínica Estomatológica Provincial Docente "Mártires del Moncada" in Santiago de Cuba from January to September, 2020. Searches concerning the importance of the use of aerosols in dental clinics and how to use it in this current pandemic were carried out in the data bases Pubmed, Medline, Science Direct, SciELO, and Google scholar. Results: The information found revealed norms, measures, clinical criteria, precautions and recommendations related to the use of aerosols in the dental clinic. Conclusions: In addition to standard precautions, it is essential to avoid the use of tools and devices that generate aerosols, since they increase the risk of SARS-CoV-2 infection. Also it is important not to remove the protection means use in the dental office, the need for workers to knowledge all protocol, among others important aspects.

RESUMO Introdução: Os aerossóis em Estomatologia são um fator muito importante a se levar em consideração, pois facilitam a transmissão bacteriana aos profissionais de saúde e ao ambiente de escritório com a dispersão de minúsculas gotas. Objetivo: Realizar uma compilação de informações que discutam o risco de transmissão do vírus SARS-CoV-2 através do uso de aerossóis em atendimento odontológico e as medidas adicionais precisas a serem levadas em conta para a prevenção do contágio à saúde pessoal desta área. Método: Realizou-se um estudo na Clínica Estomatológica Provincial Docente "Mártires del Moncada", em Santiago de Cuba, no período de janeiro a setembro de 2020, consistindo numa revisão bibliográfica. A busca foi realizada nas bases de dados bibliográficas Pubmed, Medline, Science Direct, SciELO e na ferramenta de busca Google Scholar, sobre a importância dos aerossóis gerados na prática odontológica em relação à atual pandemia. Resultados: As informações encontradas expressam as normas, medidas, critérios clínicos, cuidados e recomendações relacionadas aos aerossóis no consultório de Estomatologia. Conclusões: Além das precauções padrão, é imprescindível evitar o uso de instrumentos e dispositivos que gerem aerossóis, pois aumentam o risco de contrair o vírus SARS-CoV-2, não retiram os meios de proteção no ambiente de escritório, a necessidade de os trabalhadores dominarem o conhecimento de todas as medidas, entre outras.

Tratamento de lesão traumática em UTI: relato de caso / Treatment of traumatic injury in the ICU: case report

O objetivo desse trabalho é relatar um caso clínico de tratamento de úlcera traumática labial utilizando protetor bucal em paciente internado em uma Unidade de Terapia Intensiva. Paciente do sexo feminino diagnosticada com uma doença neurodegenerativa apresentou uma lesão de aspecto ulcerado, de aproximadamente 12 mm na mucosa do lábio inferior. O diagnóstico foi de úlcera traumática decorrente de espasmos musculares involuntários em face. O tratamento proposto foi instalação de protetor bucal confeccionado a partir de uma moldeira pré-fabricada de EVA (etil-vinil-acetato) borrachóide associado à medicação tópica a base de corticosteroide sobre a lesão. Após 5 dias foi observada cicatrização completa da úlcera, dispensando o uso do dispositivo. Nos dias seguintes de internação não foram observadas novas lesões. O protetor bucal instalado mostrou-se efetivo no afastamento do tecido traumatizado de novos traumas, protegeu os tecidos não lesionados e proporcionou qualidade de vida e segurança à paciente. Este relato reforça a importância da Odontologia na assistência do paciente crítico... (AU)

The objective of this work is to report a clinical case of treatment of traumatic lip ulcers using mouth guard in a patient admitted to an Intensive Care Unit. Female patient diagnosed with a neurodegenerative disease presented with an ulcerated lesion, of approximately 12 mm in the mucosa of the lower lip. The diagnosis was a traumatic ulcer resulting from involuntary muscle spasms in the face. The proposed treatment was the installation of a mouthguard made from a prefabricated EVA (ethyl vinyl acetate) rubber mold associated with topical corticosteroid medication on the lesion. After 5 days, complete healing oh the ulcer was observed, dispensing with the use of the intraoral device. In the following days of hospitalization, no new injuries were observed. The installed mouthguard proved to be effective in removing traumatized tissue from new traumas, protecting uninjured tissues and providing quality of life and safety to the patient. This report reinforces the importance of Dentistry in the care of critical patients... (AU)

Safety protocols for dental care during the COVID-19 pandemic: the experience of a Brazilian hospital service

Abstract The coronavirus disease (COVID-19) has been prioritized in relation to other illnesses considered critical, such as cancer, cardiovascular diseases/stroke, diabetes, and autoimmune diseases. The management of patients with these diseases involves dental care to reduce systemic complications caused by odontogenic infections, and/or to treat oral manifestations of systemic comorbidities. In this regard, the dental care of these individuals must be guaranteed during the pandemic. Although a high risk of exposure to and catching of COVID-19 is expected to befall dental professionals, biosafety guidelines reduce the likelihood of infection. Thus, the current scenario poses challenges, and offers decision-making approaches and tools that facilitate the management of individuals with oral manifestations of chronic and/or critical diseases, using hospital-based services. This article presents an overview for hospital service providers who are at the forefront of COVID-19 care, including a secure protocol, and clinical guidelines based on the experience of the Hospital das Clínicas in Belo Horizonte, a public referral service, supported by the Brazilian National Health System.

A retrospective study on the oral health of patients in the intesive care unit / Um estudo retrospectivo sobre a condição bucal de pacientes em unidade de terapia intensiva

Introduction: the oral condition of patients in the Intensive Care Unit (ICU) is extremely important for clinical status monitoring, as lesions in the oral mucosa may imply complications and worsening of the health status of these patients. A higher probability of adherence, colonization, and bacterial infection in the oral cavity of patients in the ICU has also been reported. The poor oral hygiene conditions of these patients may be related to the reduction of salivary flow and difficulties in maintaining oral hygiene in a hospital environment, which rarely employs dentists on staff. Objective: to analyze the dental condition of patients admitted to the ICU of Roberto Santos General Hospital, Salvador, Bahia, Brazil. Methodology: a total of 73 patients were evaluated through an oral examination performed with a wooden spatula and sterile gauze under natural light, and data were collected and analyzed. Results: The most commom oral lesions were tongue-coating (41%) and ulcerations in the oral mucosa caused by trauma or dehydration (19.1%). The occurrence of pseudomembranous candidiasis (8.2%), dehydration of the lips and mucosa (26%), and angular cheilitis (9.5%) was additionally recorded. It was observed that 31.5% patients had more than 10 days of hospitalization and of these, 26% presented pseudomembranous candidiasis. This clinical condition was not seen in patients with a shorter hospital stay. Conclusions: this study suggest a possible association between the length of stay of these patients and the clinical conditions presented. Thus, the results of this study may guide preventive and curative measures implemented by dental surgeons who may, in the future, be part of the multidisciplinary team of professionals working in the hospital environment, especially in ICUs.

Introdução: a condição oral de pacientes internados em Unidade de Terapia Intensiva (UTI) é de extrema importância na evolução do quadro clínico desta população, já que lesões na mucosa oral podem implicar em complicações e agravo do estado de saúde destes indivíduos. Tem sido relatado também maior probabilidade de aderência, colonização e infecção bacteriana na cavidade oral de pacientes que se encontram em leitos de UTI. As condições precárias de higiene oral que estes pacientes normalmente apresentam podem estar relacionadas à redução do fluxo salivar e às dificuldades de higienização oral inerentes ao ambiente hospitalar, o qual geralmente não conta com cirurgiões-dentistas integrando a equipe de profissionais da instituição. Objetivo: a presente pesquisa visou analisar a condição odontológica de pacientes internados na Unidade de Terapia Intensiva do Hospital Geral Roberto Santos. Metodologia: setenta e três foram avaliados através de um exame bucal, realizado com espátula de madeira e gaze estéril sob a iluminação de luz natural e seus dados foram coletados e analisados. Resultados: as lesões orais mais comuns foram saburra lingual (41%) e ulcerações na mucosa oral provocadas por trauma ou ressecamento (19,1%). A ocorrência de candidíase pseudomembranosa (8,2%), lábios e mucosas desidratados (26%) e queilite angular foi adicionalmente registrada. Foi observado que dos 31,5% dos pacientes com mais de 10 dias de internação, 26% apresentaram candidíase pseudomembranosa. Essa condição clínica não foi observada em pacientes com menor tempo de internação. Conclusão: o presente estudo sugere uma possível associação entre o tempo de internação destes pacientes e as condições clínicas apresentadas. Desta forma, a descrição dos resultados desta investigação pode contribuir para nortear os cuidados preventivos e curativos a serem adotados por cirurgiões-dentistas que futuramente integrem a equipe multidisciplinar de profissionais que atuam no ambiente hospitalar, em especial, nas unidades de terapia intensiva.

Evaluation of six years of dental referrals from the pediatric inpatient area of Hospital Criança Conceição in Porto Alegre, Brazil / Evaluación de seis años de interconsultas odontológicas provenientes del área de internación pediátrica del Hospital Criança Conceição de Porto Alegre, Brasil

Abstract Introduction: this study aimed to describe the profile of the referrals sent to the hospital dentistry team from patients in Hospital Criança Conceição in Porto Alegre, Rio Grande do Sul, Brazil, from January 2012 to July 2018. Methods: a descriptive, retrospective study was conducted, evaluating 193 electronic dental records to extract the following data: patient's sex and age, description of the referral made by other health professionals and the dentist's behavior in solving the presented problem. Results: 61.6% of patients were male and the mean age of all patients was 10.5 years. Most dental referrals came from the oncohematology area (75.12%) and the predominant reason was pre- and post-chemotherapy patients' dental care (40.4%). The diagnosis most commonly found by dentists was mucositis (17.6%) and caries (16%). There was absence of oral diseases in 23.8% of cases. The interventions most commonly performed by the hospital dentistry team were laser therapy (57.5%) and oral hygiene instructions (49.1%) in the hospital setting, while procedures in dental offices and surgical rooms included exodontias (27.7%) and restorations (11.7%). Conclusions: the profile of referrals sent to the hospital dentistry team from patients hospitalized in the Hospital Criança Conceição in Porto Alegre, Rio Grande do Sul, Brazil, is inadequate, since there was a lack of transdisciplinary management including dental care, in addition to poor use of information technology resources and lack of more objective medical records for easy retrieval of patient health information.

Resumen Introducción: este estudio pretende describir el perfil de las interconsultas enviadas al equipo de odontología hospitalaria provenientes de pacientes internados en el Hospital Criança Conceição de Porto Alegre, Rio Grande do Sul, Brasil, en el período de enero de 2012 a julio de 2018. Métodos: estudio descriptive retrospectivo en el que se evaluaron 193 historias clínicas odontológicas electrónicas para extraer los siguientes datos: sexo y edad del paciente, descripción de la interconsulta realizada por otros profesionales de salud y conducta del cirujano dentista frente al problema presentado. Resultados: el 61,6% de los pacientes fue de sexo masculino y la edad promedio general fue 10,5 años. Las interconsultas más solicitadas para los cirujanos dentistas fueron provenientes del área de oncohematología (75,12%) y el motivo predominante fue sobre el cuidado bucal a pacientes pre y posquimioterapia (40,4%). El diagnóstico que más encontraron los dentistas fue mucositis (17,6%) y lesiones de caries (16%). Hubo ausencia de enfermedades bucales en 23,8% de los casos. Las intervenciones más realizadas por el equipo de odontología fueron aplicaciones de laserterapia (57,5%) y orientaciones de higiene bucal (49,1%) en ámbito hospitalario; en sillón dental y sala quirúrgica, fueron exodoncias (27,7%) y restauraciones (11,7%). Conclusiones: el perfil de las interconsultas enviadas al equipo de odontología hospitalaria provenientes de pacientes internados en el Hospital Criança Conceição de Porto Alegre, Rio Grande do Sul, Brasil, es inadecuado, pues se demostró falta de manejo transdisciplinar que incluya odontología, además de la necesidad de un mejor aprovechamiento de los recursos de tecnología de información e historias clínicas más objetivas y que permitan obtener más fácilmente la información de salud de los pacientes.

Hospital Dentistry and Dental Care for Patients with Special Needs: Dental approach during COVID-19 Pandemic / Odontologia Hospitalar e Assistência Odontológica para Pacientes com Necessidades Especiais: Abordagem odontológica durante a Pandemia de COVID-19

Introduction: The COVID19 pandemic brought a new panorama for the realization of dental treatment for the general population due to the risk of cross infection in the dental office, aerosol formation and insertion of new personal protective equipment. Emergency and emergency dental criteria were defined to limit the flow of patients in the office in order to improve biosafety conditions among patients. Objective: to describe the dental procedures pertinent to outpatient special care or during hospitalization in the COVID19 pandemic, changes in care and implement biosecurity criteria. Basic procedures: The dental care of the special patient suffers changes, mainly referring to the difficulty of access to the offices, interruption of the conditioning process and difficulty to perform outpatient sedation and sedation with nitrous oxide. Dental care during hospitalization is essential in this patient due to prolonged time of tracheal oro intubation, traumatic oral lesions, preparation of specific oral care protocols, removal of mouth infectious and installation of mouth protectors. Conclusion: Change of care, inclusion of individual protection equipment and new knowledge about the COVID19 allows us to safely assist the patient with special needs both in the dental office and in hospital environment, providing quality of life, oral comfort and reducing oral infections during and after the pandemic. (AU)

Introdução: A pandemia por COVID19 trouxe um novo panorama para a realização do tratamento odontológico para a população em geral devido ao risco de infecção cruzada no consultório odontológico, formação de aerossóis e inserção de novos equipamentos de proteção individual. Critérios de emergência e urgência odontológicos foram definidos para limitar o fluxo de pacientes no consultório com o objetivo de melhoras as condições de biossegurança entre os pacientes. Objetivo: Citar os procedimentos odontológicos pertinentes ao atendimento de paciente com necessidades especiais em âmbito ambulatorial ou hospitalar durante a pandemia por COVID19, alterações nos fluxos de atendimentos e cuidados inerentes a assistência. Procedimentos básicos: O atendimento odontológico do paciente com necessidades especiais sofreu alterações, principalmente referente a dificuldade de acesso aos consultórios, interrupção do processo de condicionamento e dificuldade para a realização de sedação ambulatorial e sedação com óxido nitroso. A assistência odontológica durante a hospitalização por COVID19 é fundamental devido ao tempo prolongado de intubação oro traqueal - lesões orais traumáticas, elaboração de protocolos de cuidados bucais específicos, remoção de focos infecciosos bucais e instalação de protetores bucais. Conclusão: Mudanças nas rotinas de atendimento, inclusão de equipamentos de proteção individual e de novos conhecimentos sobre a COVID19 faz com que possamos atender com segurança o paciente com necessidades especiais tanto no consultório odontológico quando em ambiente hospitalar, proporcionando qualidade de vida, conforto oral e redução das infecções bucais durante e após a pandemia. (AU)

An investigation on the need, the utilization, and the influencing factors of dental services for pre-school children in selected areas in Chongqing province / 华西口腔医学杂志

OBJECTIVE@#The aim of this study is to survey the need, the utilization, and the influencing factors of dental services for children in selected areas in Chongqing province by investigating their oral health status. The survey will provide references for preventive oral health care in targeted Chongqing areas, which may improve the level of oral health among pre-school children.@*METHODS@#Random cluster sampling was utilized according to standards of the Fourth National Oral Health Epidemiological sampling survey, and 1 300 children between the ages of three and four years old from 24 kindergartens in 12 subdistricts of three areas in Chongqing were interviewed for free dental checkups and to participate in the survey. The questionnaires were designed according to the Anderson model and were answered by the children's parents. The results were analyzed utilizing Chi-square test logistic regression.@*RESULTS@#The prevalence rate of caries among the pre-school children in selected areas of Chongqing was 55.4%, the decay, missing, filled surface (dmfs) was 6 696, the mean dmfs was 5.2, and the caries filling constituent ratio was 2.3%. A total of 1 173 questionnaires were analyzed. The ratio for seeing a dentist for therapeutic reasons was 6.31% (74/1 173) and for prevalence was 22.93% (269/1 173).@*CONCLUSIONS@#The oral health service needs of pre-school children in selected areas of Chongqing are large and the oral health service utilization rate is low. Oral health care processes are arduous; thus, targeted oral prevention policies should be created.

Adaptación y validación de un instrumento con la metodología SERVQUAL en clínicas de docencia y servicios estomatológicos / Adaptation and validation of an instrument with SERVQUAL methodology in teaching clinics and stomatological services

Resumen: Objetivo: Adaptar y validar un instrumento para evaluar la calidad, en las clínicas de docencia y Servicio de Estomatología con la metodología SERVQUAL. Material y métodos: Estudio descriptivo, transversal, observacional y prospectivo validado con una alfa de Cronbach. Se diseñó un instrumento con la metodología de SERVQUAL de Parasuraman, Zeithaml y Berry (P, Z y B) aplicándose a una muestra aleatoria estratificada constituida por 400 pacientes de las clínicas de docencia y servicio de la Benemérita Universidad Autónoma de Puebla (BUAP). Para su elaboración se tomaron en cuenta las cinco dimensiones propuestas por los autores: tangibilidad, fiabilidad, capacidad de respuesta, seguridad y empatía. Resultados: El instrumento reportó una validez clasificable como excelente de acuerdo (criterios de George y Mallery) con un valor alfa de Cronbach de 0.967 para la primera parte del instrumento correspondiente a «expectativas¼ y la segunda parte correspondiente a «percepciones¼ con 0.923. Discusión: Derivado de la validación a través del análisis factorial y los altos índices obtenidos con el índice del alfa de Cronbach ambas partes del instrumento permanecieron sin cambio. Conclusiones: En los servicios de salud existen un gran número de instrumentos validados para identificar el grado de satisfacción, sin embargo, cada instrumento debe identificar y ubicar en cada una de las dimensiones del modelo seleccionando los procesos realizados en los servicios a evaluar para obtener resultados objetivos. La confiablidad, validez y aplicabilidad del instrumento cumplió con esas expectativas.

Abstract: Objective: Adaptation and validation of an instrument designed to evaluate quality in teaching clinics and stomatological services with SERVQUAL methodology. Material and methods: Descriptive, cross-sectional observational and prospective study validated with alpha Cronbach coefficient. Parasuraman, Zeithaml and Berry (P, Z and B) designed an instrument with SERVQUAL methodology; it was applied to a stratified, randomized sample composed of 400 patients coming from teaching clinics and services of the Emeritum Autonomous University of Puebla (BUAP). For manufacture of said sample the following five dimensions proposed by authors were taken into account: tangibility, reliability, response capacity, security and empathy. Results: Instrument reported validity classifiable as excellent, according to an 0.967 alpha Cronbach value for the first part of the instrument corresponding to «expectations¼, the second part corresponding to «perceptions¼ rated 0.923. Discussion: Derived from validation through factorial analysis and high indexes obtained with alpha Cronbach index, both parts of the instrument remained without changes. Conclusions: Within the sphere of health services there is a great number of instruments validated to identify the level of satisfaction, nevertheless, each instrument must identify and locate within the dimensions of the selected model processes conducted in services to be evaluated, in order to obtain objective results. Reliability, validity and applicability of the instrument met with aforementioned expectations.

A importância da saúde bucal em pacientes hospitalizados: uma revisão / The importance of oral health in hospitalized patients: a review

Existe uma relação importante entre o estado de saúde bucal e aquele da saúde geral. Em pacientes hospitalizados essa relação assume importância ainda maior, pois o indivíduo encontra-se fragilizado e, muitas vezes, é incapaz de realizar uma higiene bucal adequada. O presente trabalho trata-se de uma revisão de literatura que tem como objetivo discutir os principais problemas bucais apresentados por pacientes hospitalizados, principalmente aqueles que ficam por longo período de tempo. A maioria dos trabalhos encontrados relata que a saúde bucal de pacientes hospitalizados por longos períodos é precária e que isso afeta diretamente a saúde geral dos mesmos. Concluiu-se que uma saúde bucal adequada pode melhorar a resposta do paciente ao tratamento médico e que a presença de cirurgiões dentistas nas equipes multiprofissionais dos hospitais é de extrema importância para a implementação de protocolos clínicos de conduta visando tanto a prevenção quanto a recuperação da saúde bucal dos pacientes hospitalizados

There is an important relationship between the state of oral health and that of overall health. In hospitalized patients this relationship is even more important because the individual is debilitated and,most of the time, is unable to perform an adequate oral hygiene. This work is a literature review that aims to discuss the main oral problems presented by hospitalized patients, especially those who stay for longer period of time. Most studies found that the oral health of hospitalized patients for long periods is precarious and that this directly affects the overall health of them. It leads to the conclusion that adequate oral health can improve a patient's response to medical treatment and that the presence of dentists in multidisciplinary teams of hospitals is of extreme importance for the implementation of clinical management protocols aimed at both prevention and recovery of oral health of hospitalized patients

A importância do cirurgião-dentista em ambiente hospitalar / The importance of the surgeon-dentist at hospital environment

A odontologia hospitalar é a prática de atividades que contribuem com a melhora da saúde geral e qualidade de vida dos indivíduos hospitalizados, os quais apresentam grandes riscos de contração de doenças infecciosas e pulmonares, que, além de prejudicar a saúde bucal, podem acometer outros órgãos e sistemas, agravando o quadro clínico e estendendo a sua estadia na Unidade de Terapia Intensiva (UTI). Assim, a presença do cirurgião dentista dentro da equipe multidisciplinar visa melhorar efetivamente o quadro de saúde geral dos pacientes. O objetivo do estudo foi realizar uma revisão de literatura e retratar a importância da atuação do cirurgião dentista na equipe multidisciplinar em ambiente hospitalar e a relação entre condições orais e sistêmicas que podem influenciar no quadro clínico do paciente internado. Foram consultadas as bases de dados Scielo, PubMed, Medline e LILACS, por meio das palavras chave em português e inglês: odontologia, unidade hospitalar de odontologia, equipe hospitalar de odontologia, unidades de terapia intensiva, intensive care units, dentistry, patient care team, patient care, no período de 2000 a 2017. Foram utilizados 21 artigos cujos achados correspondem a 9 revisões de literatura, 10 artigos observacionais e 2 legislações sobre o tema. Em conclusão, é fundamental a integração do cirurgião dentista habilitado em Odontologia hospitalar dentro das UTIs para realização de medidas preventivas bucais e para melhoria do quadro clínico dos pacientes internados. (AU)

The hospital dentistry is the practice of activities that contribute with the improve of general health and the quality of life of hospitalized individuals, which present big risks of infectious and pulmonar diseases contraction, which in addition to impairing the oral health, can effect other organs and systems, aggravating the patient's clinical condition and keeping it for more time at Intensive Care Unit (ICU). So the presence of a surgeon-dentist into the multidisciplinar team aims to effectively improve the patient's clinical conditions. The objective was to realize a literature review and show the importance of the surgeondentist performance in a multidisciplinar team in hospital environment; also the relationship between oral and systems conditions, that can influence in admitted patient's clinical conditions. It was consulted the Scielo, PubMed, Medline and LILACS data bases, using the keywords in Portuguese and English: intensive care units, dentistry, patient care team, patient care, odontologia, unidade hospitalar de odontologia, equipe hospitalar de odontologia, unidades de terapia intensiva, in the period from 2000 to 2017. Twenty-one articles were used, which findings correspond to 9 literature review, 10 observational articles and 2 laws about the subject. In conclusion, the integration of the enabled surgeon-dentist in hospital dentistry is fundamental into ICU for oral preventive measures and also to improve the admitted patient's clinical conditions. (AU)

Survey of Dental Service Ability in Yunnan Province / 昆明医科大学学报

Objective To investigate the ability of dental service in Yunnan province by analyzing the distribution of oral medical institutions,the distribution of oraloral medical staffs,the per capita outpatient costs,and the rate of visiting the doctor.Methods A general survey on oral medical institutions was finished by using questionnaires.Results There were 1045 dental institutions,416 of them were public dental institutions.305 were in Kunming.305 dental institutions were in Kunming,the number of dental institutions per square kilometer was 14.2,the dental manpower index wasl5,the rate of visiting the doctor was 14.19％,per capita outpatient costs were 139.9 Yuan,and the above indexes were ranked first in Kunming.Conclusions In Yunnan province,oral health resources distribution were imbalanced.Dental service ability was uneven,perfect oral disease diagnosis and treatment quality control systems needs to be established,including cultivating specialized nurses relieve the tense situation of oral health care resources,and implenting the four hand operation,so as to effectively improve the quality of medical services.

Related factors between quality of dental service and Korean net promoter score / 대한구강보건학회지

OBJECTIVES: Many people rely on recommendations from family, relatives, and other information sources in order to select the appropriate dental clinic for treatment. The object of this study was to find out the relationship between quality of dental service and Korean Net Promoter Score (KNPS). METHODS: A total of 520 patients were selected through consecutive sampling from four dental clinics in Daegu city. Informed consent of all selected patients was obtained. The patients were required to complete a questionnaire that comprised of three categories of queries related to provision of satisfactory dental service, relation quality, and personal data. Sub-categories of questions included physical and environmental factors, human service factors, patients' satisfaction with related quality and KNPS. Data was collected by interviewing all individuals on a personal basis over a period of 3 months. Statistical analysis was performed using studental t-test, ANOVA and multiple regression analysis using the SPSS 20.0 software (IBM Co., Armonk, NY, USA). RESULTS: Among the various socio-economic factors studied, income was most significantly related to KNPS while satisfaction of relation quality was the largest factor affecting the KNPS. Factors such as satisfactory physical environment, quality of human service, relation quality and income accounted for 52.4% of KNPS. In short, the three major factors that affected KNPS were patient compliance, professionalism of the attending dentist and response of hygienist to patient. Other minor factors influencing KNPS included trust upon the attending dentist, aesthetics of clinicstiinterior, and physical convenience. CONCLUSIONS: It is highly recommended that dental clinics should make strenuous efforts to increase the level of patient compliance, professionalism, and response towards patients, which can be achieved by improving the quality of service and through positive marketing of the hospital.

Microbial diversity in dental unit waterlines

Dental health care providers and patients are exposed duringongoing work to contamination by the water used in the dentalunits, due to accidental swallowing or aspiration of thesprays generated by the high-speed handpiece and the threewaysyringe. This study evaluated the quality of water indental units in the public dental care system of Maceió,Alagoas, Brazil, by conducting analyses of contamination bytotal coliforms, E.Coli, heterotrophic bacteria and filamentousfungi. We collected 200 mL of water at 5 sites in 6 dentaloffices of the Department of Health located in different partsof the city. A total 212 isolates and 16 genera of filamentousfungi were identified in the water collected from the dentalunits. Total coliforms indicated that the water used in dentalunits was not appropriate for human consumption. The highlevels of contamination found in this study showed that waterwas a potential source of cross-infection...

Durante a rotina de trabalho, a equipe odontológica e ospacientes ficam expostos a possível contaminação pela água utilizadanas unidades dentais, devido à ingestão acidental da águaou pela aspiração dos sprays gerados pela caneta de alta rotaçãoe seringa tríplice. Este estudo avaliou a qualidade da água usadaem consultórios odontológicos da rede pública estadual deMaceió, Alagoas, Brasil, através da análise de contaminação porcoliformes totais e E.coli, bactérias heterotróficas e fungos filamentosos.Foram coletados 200 mL de água, em cinco pontos deseis consultórios odontológicos pertencentes à Secretaria Estadualde Saúde, localizados em diferentes bairros da cidade. Umtotal de 212 isolados e 16 gêneros de fungos filamentosos foramidentificados. A presença de coliformes totais indicou que a águautilizada nas unidades dentais era imprópria para consumohumano. O alto índice de contaminação mostrou que as águasestudadas eram uma fonte potencial de infecções cruzadas...

Demanda do serviço de odontologia clínica do Hospital Santa Catarina de Blumenau- SC / Demand of the dental clinic service of Santa Catarina hospital in Blumenau-SC

Introdução: no que concerne a saúde bucal, o ambiente hospitalar deve ser um espaço de interação multiprofissional em que a ação de cirurgiões-dentistas, enfermeiros, médicos, técnicos e equipes de apoio coexistam de forma harmônica e complementar. Objetivo: Verificar a demanda do Serviço de Odontologia Clínica do Hospital Santa Catarina, de Blumenau - SC. Método: Esta investigação se caracterizou como um estudo exploratório, mediante o levantamento de dados secundários. Os dados foram obtidos junto aos prontuários do sistema Tasy® do Hospital Santa Catarina. Foram analisados 203 prontuários de pacientes avaliados pelo serviço de Odontologia Clínica, no período de julho de 2006 a julho de 2010. Os dados foram registrados e agrupados com auxílio do programa Excel do WindowsXP, sendo calculada a frequência relativa. Após, foram apresentados em tabelas. Resultados: O serviço de Odontologia Clínica do Hospital, no período avaliado, obteve um índice médio mensal de chamadas de 4,22. A maior frequência foi para realização de avaliação odontológica preventiva (75,0 por cento) e para avaliação pré-cirurgia cardíaca (15,0 por cento) dos pacientes internados. A especialidade médica que mais chamou pelo serviço odontológico foi a cardiologia (41,8 por cento). Conclusão: Diante dos resultados obtidos nesse estudo, concluiu-se que a integração da Odontologia com as diferentes especialidades médicas, no ambiente hospitalar, ainda é pequena, tendo em vista a constatação da baixa demanda pelos cuidados odontológicos.

Introduction: In what regards buccal health, the hospital should be a space for multidisciplinary interaction in which the action of dentists, nurses, doctors, technicians and support teams coexist in a harmonious and complementary. Objective: To verify the demand of Dental Clinic Hospital Santa Catarina Service, (Blumenau-SC). Method: This research was characterized as an exploratory study through secondary data collection. The data obtained were from 203 patient records from the Tasy ® system of Hospital Santa Catarina in Blumenau-SC, collected for the period of July 2006 to July 2010. The data were recorded and grouped with the aid of Excel program of Windows XP, being calculated relative frequency. Data was registered and grouped with the aid of the Windows XP Excel program, the relative frequency being calculated. After, were presented in tables. Results: The service Dental Clinic Hospital, during this period, obtained a mean of 4.22 calls. The highest frequency for performing was preventive dental evaluation (75.0 per cent) and pre cardiac surgery assessment 15.0 per cent of interned patients. The medical specialty that most requested the dental service was the Cardiology (41.8 per cent). Conclusion: From the results obtained in this study, it was concluded that the integration of dentistry with the different medical specialties in the hospital environment it is small, because the demand for dental care was low.

Practice and reflection on innovative development of scientific researchers in Peking University School of Stomatology / 中华医学科研管理杂志

Currently,some university affiliated hospitals focus their management attention more on clinical practice than scientific research and researcher development. On the practice of researchers development,Peking University School of Stomatology established a Going-Out strategy and strengthened post-doctoral training programs,which provides a platform for researchers to improve.Team-building is also emphasized and international cooperation is encouraged.

Nem tudo é estágio: contribuições para o debate / Not everything is supervised training: contributions for the debate

O artigo versa sobre o estágio supervisionado, tratando-o como uma oportunidade fundamental de consolidação do espaço pedagógico, capaz de enfrentar, positivamente, os desafios lançados pelas Diretrizes Curriculares para os Cursos de Graduação em Odontologia. Não se trata de uma proposta nova, mas de uma luta pela transformação das práticas de ensino que tem origem nos anos setenta, no movimento de integração docente assistencial, até os dias atuais. Aborda o espaço dos serviços públicos de saúde e o mundo do trabalho como aspectos centrais de uma nova prática pedagógica, com potencial para se alcançar um perfil profissional com consciência crítica e capacidade de compreender a realidade e intervir sobre ela. Aponta para os riscos de se compreender e confundir estágio com prática intramuros, reproduzindo, sob o nome de estágio curricular supervisionado, práticas tradicionais, com ênfase em aspectos tecnicistas e biologicistas sem potência para alcançar as mudanças propostas pelas Diretrizes Curriculares. Ao ressaltar a importância do estágio curricular supervisionado na formação profissional, fica estabelecido um diálogo com a ABENO, contestando algumas de suas posições. Neste sentido, o artigo mostra a necessidade de uma discussão que agregue o maior número possível de faculdades de odontologia.

This paper discusses supervised training as a fundamental opportunity for the consolidation of the teaching space and also as means of facing the challenges posed by the guidelines for dental courses. It is not a new proposal. It is in fact a fight for changes in dental practicing which began in the 70s with the movement for the integration between dental teaching and dental services. It approaches public health services spaces and the world of work as central for a new teaching strategy. That would generate the opportunity to graduate professionals with a more critical profile, also capable of understanding reality and intervening on it. The paper points the risks of understanding and misunderstanding - supervised training with practicing inside the dental school, under the label of curricular supervised training. In that perspective traditional practices, with emphasis on technical and biological aspects would not have the potential to achieve the changes proposed by the curricular guidelines. While highlighting the relevance of curricular supervised training in professional education, the paper sets a dialogue with ABENO, contesting some of its positions. In that sense, the paper shows the need for a deeper and more participative discussion, that joins as many dental schools as possible.

Perfil do serviço de pronto atendimento odontológico da Universidade Federal de Pernambuco / Profile of ready attendance odontologic service of Federal University of Pernambuco

O objetivo deste trabalho foi identificar o perfil dos atendimentos prestados pelo Serviço de Pronto Atendimento Odontológico da Universidade Federal de Pernambuco no período de 14/06/2004 a 14/06/2005. Foram analisadas 1.576 fichas de atendimento clínico, das quais foi observada uma predominância de indivíduos do sexo feminino (68,02%); faixa etária que apresentou maior número de atendimento (391) foi a de 21 a 30 anos; a queixa principal mais frequente relatada pelos pacientes foi dor (66,42%) e os procedimentos mais realizados foram endodônticos (41,88%). Concluí-se que o atendimento clínico de urgência da UFPE presta valiosa contribuição à saúde da população da cidade do Recife e regiões vizinhas.

The objective of this paper was to identify the profile of ready attendance odontologic service of Federal University of Pernambuco in the period of 14/06/2004 to 14/06/2005. The 1.576 handbooks of attendance had been analyzed, was observed the predominance of female individuals (68,02%), the age that was observed greater number of consultation (391) was between 21 and 30 years, the majority of the consultations was in the City of Recife (1064), the more frequent main complaint told by the patients was pain (66,42%) and the procedures more frequently realized was endodontics (41,88%). We conclude that the first aid attendance of the UFPE has a valuable contribution to the health of the population of the city of Recife and neighboring regions.

Odontologia hospitalar no Brasil. Uma visão geral / Hospital odontology in Brazil. A general vision

O cuidado com a saúde em âmbito hospitalar exige o trabalho em equipemultidisciplinar, fato que demandou a introdução da Odontologia nesse ambiente de trabalho. No ambiente hospitalar, as responsabilidades são compartilhadas entre médicos, cirurgiões-dentistas e toda equipe assistente. De modo geral, nos hospitais são atendidos pacientes cuja condição de saúde contraindica ou impede a realização de intervenções no consultório odontológico, devido à falta de infraestrutura ou mesmo à ausência de uma equipe auxiliar treinada. Por outro lado, o atendimento odontológico a pacientes hospitalizados portadores de enfermidades sistêmicas contribui efetivamente para a recuperação destes. Desse modo, o cirurgião-dentista deve estar presente nos hospitais e deve estar preparado para o atendimento odontológico, em condiçõesespecíficas e diferenciadas do cotidiano do consultório. Para o paciente em regime de convalescença ou tratamento, a assistência odontológica em ambiente hospitalar é favorecida por contar com maiores recursos diante de situações de urgência e emergência, além do trabalho, quando em equipe, proporcionar melhores condições de saúde ao paciente. O objetivo deste estudo foi realizar uma revisão da literatura, buscando informações sobre a Odontologia hospitalar no Brasil.

The care with the health in hospital demand the work in discipline multiple team, fact that demanded the introduction of the Odontology in this environment of work. In the hospital environment, the responsibility must be shared between doctors, dentist and all team assistant. Ingeneral, in the hospital are treated patients whose health counter-indicates or obstruct the realization of intervention in the dental office, it is due to lack of infrastructure or even the absence of teamassistant. On the other hand, the dental care for hospitalized patients with systemic diseases contributes effectively to the recovery. Thus, the dentist must be present in hospitals and should be ready for the dental care in particular conditions and differentiated from the office routine. For the patient in regime of convalescence or treatment, the Odontology in hospital environment is benefit for to count on with bigger resource for urgency and emergence, beyond the workplace, when a team, provide better health conditions of the patient. The objective of this study was to achieve a review of literature searching information about the hospital Odontology in Brazil.