Atendimento odontológico de pacientes com necessidades especiais na atenção secundária em um estado do nordeste do Brasil / Dental care of special needs patients in secondary care in a northeastern state of Brazil / Atención odontológica a pacientes con necesidades especiales en la atención secundaria en un estado del nordeste de Brasil

O objetivo desse estudo foi descrever a produção dos atendimentos oferecidos aos pacientes com necessidades especiais nos Centros de Especialidades Odontológicas (CEO) da Paraíba (Brasil) e sua relação com o cumprimento das metas de produtividade, entre o período de 2019 e 2022. Trata-se de um estudo descritivo e ecológico em que foram coletados dados secundários do Sistema de Informações Ambulatoriais do SUS (SIA/SUS), através da captação da produção ambulatorial individualizada (BPA-I), por meio da ferramenta TabWin, dos 98 CEO operantes na Paraíba. Realizou-se análise descritiva e analítica, por meio dos testes Qui-Quadrado de Pearson e Exato de Fisher entre a variável dependente "alcance da meta" e a variável independente "adesão à Rede de Cuidados à Pessoa com Deficiência (RCPD)". Em todos os anos, a porcentagem de CEO cumpridores da meta (15,3% em 2019; 1% em 2020; 12,2% em 2021; e 11,2% em 2022) foi substancialmente menor que os números expressados por aqueles que não alcançaram a produção mínima. Os resultados também apontaram maior realização de procedimentos restauradores (29,6% em 2019; 28,6% em 2020; 32,7% em 2021; e 37,8% em 2022) em detrimento aos periodontais, cirúrgicos e preventivos. No que concerne a estar aderido à RCPD, no ano de 2022, 90,9% dos CEO que alcançaram a meta estavam aderidos à Rede (p<0,05). Concluiu-se que uma baixa frequência de CEO alcançou o cumprimento da meta de produtividade da especialidade de Odontologia para Pacientes com Necessidades Especiais nos CEO. No entanto, a adesão à RCPD manifestou-se como elemento influenciador para aqueles que cumpriram suas metas mensais e anuais.

The objective of this study was to describe the production of care provided to special needs patients in the Dental Specialties Centers (CEO) of Paraíba (Brazil) and its relationship with the achievement of productivity goals, between the period 2019 and 2022. This is a descriptive and ecological study in which secondary data were collected from the SUS Outpatient Information System (SIA/SUS), by capturing the individualized outpatient production (BPA-I), through the TabWin tool, of the 98 operating CEOs in Paraíba. We carried out descriptive and analytical analysis, using Pearson's Chi-square and Fisher's Exact tests between the dependent variable "goal attainment" and the independent variable "adherence to the Care Network for People with Disabilities (RCPD)". In all years, the percentage of CEOs meeting the goal (15.3% in 2019; 1% in 2020; 12.2% in 2021; and 11.2% in 2022) was substantially lower than the numbers expressed by those who did not meet the minimum output. The results also indicated greater performance of restorative procedures (29.6% in 2019; 28.6% in 2020; 32.7% in 2021; and 37.8% in 2022) to the detriment of periodontal, surgical, and preventive procedures. Regarding being adhered to the RCPD, in the year 2022, 90.9% of the CEOs who reached the goal were adhered to the Network (p<0.05). It was concluded that a low frequency of CEOs achieved compliance with the productivity target of the specialty of Dentistry for Special Needs Patients in CEOs. However, adherence to the RCPD manifested itself as an influential element for those who met their monthly and annual goals.

El objetivo de este estudio fue describir la producción de la atención prestada a pacientes con necesidades especiales en los Centros de Especialidades Odontológicas (CEO) de Paraíba (Brasil) y su relación con el alcance de las metas de productividad, entre el período de 2019 y 2022. Se trata de un estudio descriptivo y ecológico en el que se recogieron datos secundarios del Sistema de Información Ambulatoria del SUS (SIA/SUS), mediante la captura de la producción ambulatoria individualizada (BPA-I), a través de la herramienta TabWin, de los 98 CEOs en funcionamiento en Paraíba. Se realizaron análisis descriptivos y analíticos, utilizando las pruebas Chi-cuadrado de Pearson y Exacta de Fisher entre la variable dependiente "cumplimiento de metas" y la variable independiente "adhesión a la Red de Atención a Personas con Discapacidad (RCPD)". En todos los años, el porcentaje de directores generales que cumplieron el objetivo (15,3% en 2019; 1% en 2020; 12,2% en 2021; y 11,2% en 2022) fue sustancialmente inferior a las cifras expresadas por los que no alcanzaron el rendimiento mínimo. Los resultados también indicaron una mayor realización de procedimientos restauradores (29,6% en 2019; 28,6% en 2020; 32,7% en 2021; y 37,8% en 2022) en detrimento de los procedimientos periodontales, quirúrgicos y preventivos. Respecto a estar adherido a la RCPD, en el año 2022, el 90,9% de los CEOs que alcanzaron el objetivo estaban adheridos a la Red (p<0,05). Se concluyó que una baja frecuencia de CEOs alcanzó el cumplimiento de la meta de productividad de la especialidad de Odontología para Pacientes con Necesidades Especiales en CEOs. Sin embargo, la adhesión al RCPD se manifestó como un elemento influyente para aquellos que cumplieron sus objetivos mensuales y anuales.

Access to Oral Health Actions According to Social and Individual Determinants

Abstract Objective: To investigate the socioeconomic, demographic and health needs that influence the access to oral health actions. Material and Methods: The sample consisted of 609 individuals who lived in areas covered by the Family Health Strategy in a city of the Northeast of Brazil. All individuals living in areas covered by the FHS with age equal to or higher than six years were included. Data analysis included descriptive, bivariate and multivariate statistics using decision-tree based Chi-squared automatic interaction detection (CHAID). Results: Most participants were female, aged 25-34 years, ranging in age from 6 to 87 years. It was evidenced that, among the studied variables, the most relevant for understanding the access to oral health actions were: age (p<0.001), educational level (p-value in Node 1 = 0.009; p-value in Node 7 = 0.005) and self-perception of oral health (p=0.001). Conclusion: The results suggest that access to oral health actions is influenced by several social and individual factors, and it is marked by inequalities that favor individuals with higher educational level, better self-perception of oral health and lower age groups.

Factors Associated with the Caregivers' Perception of the Oral Health of Individuals with Cerebral Palsy

Abstract Objective: To evaluate factors associated with the caregivers' perception of the oral health of children and adolescents with cerebral palsy. Material and Methods: A cross-sectional study was carried out with 80 children and adolescents with cerebral palsy aged 2-18 years, registered at a reference institution and their respective caregivers. Caregivers provided socioeconomic, systemic and health perception and access to dental services data. A calibrated researcher (Kappa=0.75-0.98) performed oral examinations using DMF-T, dmf-t, dental trauma, gingival bleeding index, community periodontal index, malocclusion index and the dental aesthetic index. The Poisson Regression was used (α=0.05) Results: According to the caregivers' perception, the oral health reports of children and adolescents with cerebral palsy considered good and poor was 73.8% and 26.3%, respectively. The poor oral health perception is associated with the presence of dental caries in anterior teeth (PR 1.34, 95% CI=1.11-1.63) and bleeding during tooth brushing (PR 1.20, 95% CI=1.04-1.40) Conclusion: Children and adolescents with cerebral palsy who presented lesions of caries in the anterior teeth and gingival bleeding during tooth brushing, more frequently, had poor oral health by their caregivers.

Prevalência de erosão dentária e fatores associados em uma população de escolares / Prevalence of dental erosion and associated factors in a schoolchildren population

Introdução: Erosão dentária é a perda irreversível de tecido dentário, sem envolvimento bacteriano, cujo aumento de prevalência, nos últimos anos, tem sido alarmante. Objetivo: Determinar a prevalência de erosão dentária, bem como fatores associados, em escolares de 06 a 13 anos, na cidade de Campina Grande, Paraíba. Material e método: A seleção das escolas foi realizada por amostragem casual simples sem reposição. Após assinatura do Termo de Consentimento Livre e Esclarecido, e do Termo de Assentimento, os exames foram realizados por um examinador previamente calibrado, com a criança sentada em uma cadeira escolar, em frente ao examinador, sob luz natural. Para a determinação da presença e do grau de erosão dentária, foi utilizado o índice de BEWE. Os dados foram analisados por meio do software Statistical Package for the Social Sciences (SPSS para Windows, versão 18.0, SPSS Inc, Chicago, IL, EUA) e adotou-se nível de significância de 5%. Resultado: A prevalência de erosão dentária na população avaliada foi de 78,2%. Não foi possível associar a presença das lesões com os fatores socioeconômicos e dietéticos. Apenas a variável Aplicação Tópica de Flúor (ATF) apresentou relação estatisticamente significativa (p=0,012). Conclusão: A alta prevalência de erosão dentária na população avaliada demonstra a necessidade da implementação de medidas assistenciais e preventivas, em curto e longo prazo.

Introduction: Dental erosion is the irreversible loss of dental tissue, without bacterial involvement, whose increased prevalence in recent years has been alarming. Objective: To determine the prevalence of dental erosion, as well as associated factors, in school children from 06 to 13 years of age, in the city of Campina Grande, PB. Material and method: Selection of schools was performed by simple random sampling without replacement. After signing the Informed Consent Term and Assent Term, the examinations were performed by a previously calibrated examiner, with the child sitting in a school chair in front of the examiner in natural light. To determine the presence and degree of dental erosion, the BEWE index was used. Data were analyzed using Statistical Package for Social Sciences (SPSS for Windows, version 18.0, SPSS Inc, Chicago, IL, USA) and a significance level of 5% was used. Result: The prevalence of dental erosion in the evaluated population was 78.2%. It was not possible to associate the presence of lesions with socioeconomic and dietary factors. Only the variable Topical Application of Fluoride (TFA) presented a statistically significant relation (p = 0.012). Conclusion: The high prevalence of dental erosion in the evaluated population demonstrates the need to implement preventive and preventive measures in the short and long term.

Satisfaction, Resolution and Social Participation of users of Centers for Dental Specialties in Brazil: A PMAQ-CEO Analysis

Objective: To describe satisfaction, resolution and social participation of users regarding the service offered in Brazilian Centers for Dental Specialties (CEOs). Material and Methods: An analysis was made of the first phase of PMAQ-CEO, developed during 2014, in which 8,897 users were interviewed. Module III of the instrument external evaluation was used, considering the socio-demographic characterization of the assisted population, and an analysis of satisfaction, resolution and social control of Brazilian CEOs. The bivariate and multivariate Poisson regression analysis with robust variance was used (α<0.05). Results: The profile of interviewed users is female, from the Northeastern region, brown color, living in the urban zone, incomplete elementary school, income of up to two minimum wages and resident of area covered by the family health strategy. The overall CEO rating is "good" (46.1%) or "very good" (49.2%). The score (0 to 10) given to reception staff and dentists was, respectively, 9.31±1.32 and 9.52±1.02. Among subjects who completed treatment (33.3%), the resolution was 95.3%. Although 89.1% stated they never needed to file a complaint, 68.4% did not know the Unified Health System ombudsman. The positive evaluation of CEO was associated with the good evaluation of professionals involved (p<0.05) and the absence of treatment interruption due to lack of material (p=0.037). Conclusion: The satisfaction of users with the services of Centers for Dental Specialties is high and treatments offered are resolutive. Social control tools need to be better known by users.

Oral Health Status of Brazilian Workers of a Textile Industry

Objective: To evaluate the oral health status of Brazilian workers of a textile industry. Material and Methods: A cross-sectional study including 489 individuals of both sexes was performed. Data on gender, age, schooling, frequency of dentist visits and caries experience (DMFT) were collected by a single trained and calibrated examiner. Data were organized using the Statistical Package for Social Sciences (SPSS) software and presented through descriptive and inferential statistics (Poisson Regression Analysis). The significance level was 5%. Results: There was predominance of female workers (57.7%) aged 30-39 years (44.6%) and with 9-11 years of schooling (79.7%). Almost all of them had visited the dentist at least once in their lifetime (99.6%), and 66.8% had done so in the last 12 months. The mean DMFT value was 11.14 (± 5.64), with higher participation of filled (6.21) and missing components (4.03). There was a statistically significant association between DMFT values (≤ 11 and ≥ 12) and age group (p <0.001), as well as between schooling and number of missing (p <0.001) and decayed teeth (p < 0.001). Conclusion: The mean DMFT of Brazilian workers is high, with a tendency to increase the number of missing teeth as age increases. Schooling was associated with the number of missing and filled teeth.

Access to Oral Health Services in Areas Covered by the Family Health Strategy, Paraíba, Brazil

Objective: To evaluate access to oral health services and associated factors in areas covered by the Family Health Strategy. Material and Methods: This is a populationbased study with a systematic random sample of 759 individuals aged ≥ 06 years of a municipality in northeastern Brazil. Data on socio-economic and demographic conditions, tooth pain severity in the last six months and issues related to access to oral health services were collected. Data were analyzed using Pearson's chi-square test and Poisson regression analysis, considering 5% significance level. All tests were performed using the Statistical Package for Social Sciences software (SPSS) version 18.0. Results: 61.7% of individuals had access to dental services, 53.5% of them in the public sector. Through Poisson multivariate regression, individuals more likely to have full access were students (PR: 3.085, 95% CI 1.75-5.43), adolescents (PR: 2.297, 95% CI 1.30-4.04), adults at reproductive phase (PR: 2.127, 95% CI 1.24-3.62) and those with toothache in the last six months (PR: 1.314, 95% CI 1.08-1.59). Illiterates and individuals with up to complete elementary school were associated with lower likelihood of having full access to oral health services. Conclusion: More than half of the sample had access to oral health services, being higher in the public sector than in the private sector. Having full access to oral health services was associated in the multivariate model with age, education and toothache in the last six months.

Efeito sobre a morfologia do esmalte dental e análise físico-química de medicamentos utilizados por pacientes pediátricos com paralisia cerebral / Effect on dental enamel morphology and physical-chemical analysis of medicines used by pediatric patients with cerebral palsy

Introdução: Muitos medicamentos pediátricos líquidos são considerados fatores de risco para a estrutura dentária. Esse potencial pode aumentar quando ingeridos de forma crônica, como é o caso do tratamento de algumas condições, tal como a paralisia cerebral. Objetivo: Avaliar o efeito sobre a morfologia do esmalte dental e as propriedades físico-químicas de medicamentos de uso contínuo indicados a pacientes infantis com Paralisia Cerebral. Material e método: A amostra foi constituída por quatro medicamentos: Fenobarbital (M1), Carbamazepina (M2), Oxcarbazepina (M3) e Domperidona (M4), todos em suspensão oral. Analisaram-se o pH, o teor de Sólidos Solúveis Totais (SST) e a viscosidade dos medicamentos. Todos os testes foram realizados em duplicata. Para análise em microscopia eletrônica de varredura (MEV), 15 blocos de esmalte bovino foram distribuídos aleatoriamente e imersos em oxcarbamazepina (n=5), carbamazepina (n=5) e saliva artificial (n=5). Os ciclos de imersão foram feitos por seis dias, durante cinco minutos, duas vezes ao dia, com intervalos de 12 horas, quando ficavam mantidos em saliva artificial. O grupo controle permaneceu em saliva artificial. Os dados foram analisados descritivamente. Resultado: Em relação ao pH endógeno, os valores variaram de 2,82 (M3) a 9,60(M1). Para o SST, as médias de maior e menor valor foram, respectivamente, de 20,5% (M3) e 46% (M1). A viscosidade variou de 6,89 mm2/s (M1) a 58 mm2/s (M3). Em MEV, observaram-se alterações sugestivas de perda de estrutura no esmalte dental em oxcarbamazepina e carbamazepina, proveniente da ação dos medicamentos analisados. Conclusão: Concluiu-se que os medicamentos líquidos pediátricos analisados, indicados a pacientes com paralisia cerebral, apresentam potencial cariogênico e erosivo, destacando-se a Oxcarbazepina.

Introduction: Many liquid pediatric medicines are considered risk factors for tooth structure. This potential may increase when taken chronically as is the case of some conditions such as cerebral palsy. Objective: To evaluate the effect on the morphology of dental enamel and the physicochemical properties of continuous use of drugs given to pediatric patients with cerebral palsy. Material and method: The sample consisted of three drugs for epilepsy: Phenobarbital (D1), Carbamazepine (D2), Oxcarbazepine (D3); and one drug for gastroesophageal reflux: Domperidone (D4). All in oral suspension. The pH, content of total soluble solids (TSS), and viscosity of the drugs were analyzed. The tests were made two measurements. For SEM analysis, 15 bovine enamel blocks were randomly distributed and immersed in oxcarbazepine (n=5); carbamazepine (n=5); and artificial saliva (n=5). The immersion cycles were made for 6 days, during 5 minutes, 2 times a day with intervals of 12 hours, when they were kept in artificial saliva. The control group remained in artificial saliva. Data were descriptively analyzed. Result: Regarding endogenous pH, values ranged from 2.82 (D3) to 9.60 (D1). For TSS, the highest and lowest mean values were, respectively, 20.5% (D3) and 46% (D1). Viscosity ranged from 6.89 mm2/s (D1) to 58 mm2/s (D3). In SEM, observed alterations suggestive of loss of structure in the enamel in oxcarbazepine and carbamazepine from the action of the drugs analyzed. Conclusion: It was concluded that the pediatric liquid drugs analyzed, indicated to patients with cerebral palsy, have the potential cariogenic and erosive, especially the Oxcarbazepine.

Evaluation of Fluoride Release, pH and Microhardness of Glass Ionomer Cements

To evaluate fluoride release, pH and microhardness of glass ionomer cements (GIC). Material and Methods:Four different cements: Vidrion ® R (G1), Vitro Fil ® (G2), Maxxion ® (G3) and Magic Glass ® (G4) and a composite resin (G5 -control group) comprised the sample. Thirty specimens were manufactured (10 mm x 3 mm) and stored in deionized water. Analyses were performed after 24 hours, 7 days and 28 days. The following devices were used for measurements: fluorometer, pH meter and microhardness tester. Data were analyzed by Kruskal-Wallis, Mann-Whitney, Friedman and Wilcoxon tests (α= 0.05) using the SPSS ® software (Statistical Package for Social Sciences) version 17. Results:GICs were able to release fluoride; however, the amount released decreased with increasing immersion time (p <0.002). The pH of all products increased over time, the lowest value was identified for Magic Glass (5.93) and the highest for Maxxion (6.94) at time of 24 h. Materials showed significant decrease in surface microhardness, especially G4 for presenting the lowest recorded values (p <0.05). Conclusion:GICs arefluoride-releasing restorative materials with pH favorable to oral homeostasis and good mechanical behavior...

Características físico-químicas de sucos de frutas industrializados: estudo in vitro / Physicochemical characteristics of industrialized fruit juices: an in vitro study

Analisar as propriedades físico-químicas de sucos de fruta industrializados com formulações em pó e prontos para consumo. Método: A amostra constituída de quatorze sucos industrializados com sabores variados, sete em pó da Tang® e sete prontos para consumo da Del valle® e Kapo®, foi analisada pelos seguintes parâmetros: pH, Acidez Total Titulável (ATT) e teor de Sólidos Solúveis Totais (SST). Todos os testes foram realizados em triplicata. Os dados foram coletados por um único examinador e analisados de forma descritiva e inferencial com o teste Kruskal-Wallis e Mann-Whitney (α=0,05) no SPSS® (Statistical Package for the Social Sciences), versão 17. Resultados: Todos os sucos estudados apresentaram pH abaixo do crítico para o esmalte, todavia os sucos em pó foram mais ácidos que os sucos prontos para consumo (p< 0,05). A mediana dos valores de ATT dos sucos prontos para consumo (0,33%) foi superior a dos sucos em pó (0,05%), sem diferenças significativas entre as amostras. Na avaliação do teor de SST, os sucos prontos para consumo apresentaram-se mais concentrados que os sucos em pó com diferença significativa estatisticamente (p< 0,05). Conclusão: Os sucos de fruta industrializados analisados apresentaram valores baixo de pH e elevado teor de SST. No entanto, estas características físico-químicas foram diferenciadas de acordo com a forma de preparação e comercialização dos sucos...

To analyze the physicochemical properties of powdered and ready-to-drink industrialized fruit juices. Method: The sample consisted of fourteen industrialized juices with different flavors – seven powdered of the Tang® brand and seven ready-to-drink of the brands Del Valle® and Kapo®. The following parameters were analyzed: pH, Total Titratable Acidity (TTA) and Total Soluble Solids Contents (TSSC). All tests were performed in triplicate. Data were collected by a single examiner and analyzed by means of descriptive statistics and Kruskal-Wallis and Mann-Whitney tests (α = 0.05) on SPSS® (Statistical Package for the Social Sciences) version 17. Results: All the juices studied were below the critical pH for enamel, but the powdered juices were more acidic than were those ready-to-drink (p<0.05). The median of TTA values regarding the ready-to-drink juices (0.33%) was higher than that of the powdered ones (0.05%), with no significant differences between samples. With regard to TSSC values, the ready-to-drink juices were more concentrated than the powdered ones with a statistically significant difference (p<0.05). Conclusion: The industrialized fruit juices analyzed herein showed low pH and high TSSC. However, these physicochemical characteristics differed according to the form of preparation and commercial presentation of the juices...

Ortodontia como tratamento da disfunção temporomandibular: determinação do nível de evidência científica da literatura / Orthodontics as a treatment of temporomandibular disorders: determination of the scientific evidence level

Objetivo: Identificar, a partir de uma revisão crítica da literatura, a evidência científica disponível sobre a Ortodontia como tratamento para Disfunção Temporomandibular (DTM).Material e Métodos: Utilizou-se uma abordagem indutiva, com procedimento estatístico-comparativo e técnica de documentação direta. Realizou-se a pesquisa bibliográficado descritor “temporomandibular disorder and orthodontics treatment” nas bases de dados PubMed, CAPES, BBO, SCIELOe Cochrane. Os dados coletados e analisados descritivamente foram: Grau de Evidência Científica (GEC) e tipo de estudo. Resultados: Do total de 1035 artigos científicos encontrados e publicados nos anos de 2000 a 2010 foram selecionados 38 estudos. A média geral do GEC dos artigos foi de 5,5. Quanto ao nível de evidência científica, 28,94%(n=11) dos estudos são de nível 5 – estudos observacionais,23,68% (n=9) nível 8 – ensaio clínico randomizado e 47,38%estudos estão distribuídos entre os níveis 1, 4, 10, 9, 6 e 2.Conclusão: O grau de evidência científica na relação de tratamento entre Ortodontia e DTM é baixo.

Objective: To identify the scientific evidence available on orthodontics as a treatment for Temporomandibular Disorders(TMD), by means of a critical literature review. Material and Methods: It was used an inductive approach, statistical comparative procedure and direct documentation technique. Literature searches were conducted using the key-word"temporomandibular disorder and orthodontics treatment” inthe databases: PubMed, CAPES, BBO, Scielo and Cochrane.The data collected and analyzed descriptively were: Scientific Evidence Level (SEL) and study type. Results: From a total of1,035 scientific papers found and published between 2000and 2010, 38 studies were selected. SEL general average ofthe papers was 5.5 As regards the scientific evidence level,28.94% (n=11) of the studies were classified as level 5 –observational studies; 23.68% (n=9) were level 8 – randomized clinical trial; and 47.38% were included among the levels 1, 4,10, 9, 6 and 2. Conclusion: The scientific evidence level foundfor the relationship between orthodontics and TMD treatment was low.

Sialolito gigante em ducto de Warton: relato de caso clínico / Giant sialolith in Warton's duct: a clinical report

Objetivo: Relatar o caso clínico de um sialolito gigante localizado no ducto de warton da glândula submandibular. Relato de caso: Paciente 59 anos, leucoderma com estado de saúde geral regular, compareceu ao serviço de cirurgia Buco-Maxilo do Hospital Santa Isabel/João Pessoa-PB com queixa de "inchaço abaixo da língua e dor quando maior salivação". Ao exame clínico intra-oral foi observado aumento de volume no trajeto do ducto de Warton no segmento de assoalho de boca e após realização de exame de imagem do tipo oclusal de mandíbula observou-se extensa imagem radiopaca em área ductal, concluindo-se assim o diagnóstico de sialolitíase do ducto de Warton. Foi realizado remoção cirúrgica sob anestesia local, com o restabelecimento da patência do ducto e normalidade do fluxo salivar. Conclusão: O diagnóstico e tratamento efetuado no relato de caso clínico descrito foram embasados na literatura e obtiveram eficácia clínica.

Objective: to report a clinical case of a giant sialolith found in the Warton's duct of the submandibular gland. Case Report: Patient 59 years, Caucasian with regular general state of health, attended the Oral and Maxillofacial Surgery service at the Santa Isabel Hospital, Joao Pessoa - PB complaining of "swelling under the tongue and pain when salivating. On intraoral clinical examination, we observed swelling in the path of Warton's duct in the mouth floor segment. After radiographical examination (mandibular occlusal radiograph), we found extensive radiopaque image in the ductal area, establishing therefore a diagnosis of sialolithiasis of Warton's duct. Surgical removal was performed under local anesthesia, with restoration of patency of the ducts and normal salivary flow. Conclusion: The diagnosis and surgical treatment described in this case report were supported by the literature and achieved clinical efficacy.

Atividade antibacteriana de tinturas à base de plantas sobre microrganismos do biofilme dental / Antibacterial activity of plant-based tinctures on dental biofilm's microrganisms

Objetivo: Avaliar a atividade antibacteriana das Tinturas (T) de Salvia officinalis - T1, Malva sylvestris - T2 e do Anacardium occidentale - T3 sobre Streptococcus mutans (ATCC 25175) e Streptococcus oralis (ATCC 10557). Material e Método: Determinou-se a Concentração Inibitória Mínima (CIM) das tinturas pela técnica de microdiluição. Utilizaram-se microplacas com 96 poços. Em cada poço, foram inseridos 100μL de caldo Brain Heart Infusion duplamente concentrado, 100μL das tinturas em concentrações que variaram de 100 a 0,78mg/mL e 10μL de inóculo bacteriano (108 UFC/mL). As microplacas foram incubadas a 37°C, por 24 horas. A CIM correspondeu à última diluição na qual se verificou ausência de precipitado bacteriano ou turvação do meio de cultura. Os testes foram realizados em triplicata, a Clorexidina 0,12% (1,2mg/mL) serviu de controle, e os dados foram analisados descritivamente. Resultados: Sobre S. mutans e S. oralis, a CIM para cada tintura foi, respectivamente, 3,12 e 0,78 (T1); 6,25 e 3,12 (T2); e 1,56 e 0,78 (T3). Clorexidina 0,12% apresentou atividade satisfatória frente às cepas testadas. Conclusão: As tinturas avaliadas apresentaram atividade antibacteriana sobre as cepas de Streptococcus spp ensaiadas.

Objective: The aim was to evaluate the Minimum Inhibitory Concentration (MIC) of tinctures from Salvia - T1 (Salvia officinalis), Malva - T2 (Malva sylvestris) and Purple Cashew - T3 (Anacardium occidentale) against Streptococcus mutans (ATCC 25175) and Streptococcus oralis (ATCC 10557). Material and Method: The MIC of tinctures was determined through the microdilution technique using 96-wells microplates. To each well were placed 100mL of BHI doubly concentrated, 100μL of the tinctures in concentrations that ranged from 100 to 0.78 mg/mL and 10 mL of microbial inoculum (1.5x108 UFC/mL). The microplates were incubated at 37°C for 24 hours. The MIC corresponded to the last dilution in which there was no presence of bacterial precipitate or turbidity in the culture medium. Chlorhexidine at 0,12% (1,2mg/mL) was used as control. Results: For S. mutans and S. oralis the MIC for each tincture were respectively 3.12 and 0.78 (T1), 6.25 and 3.12 (T2), 1.56 and 0.78 (T3). Chlorhexidine 0.12% presented satisfactory activity against the studied strains. Conclusion: The analyzed tinctures presented antibacterial activity against the evaluated strains of Streptococcus.

Evidência científica em pesquisas sobre câncer bucal, publicadas na base de dados Scielo, no período de 2001 a 2011 / Scientific evidence in oral cancer researches published in the Scielo database for the period 2001-2011

OBJETIVO: Avaliar o nível de evidência científica dos artigos indexados na base de dados SciELO, sobre o tema câncer bucal, de 2001 a 2011. MATERIAL E MÉTODOS: Utilizou-se abordagem indutiva, com procedimento estatístico descritivo, técnica de documentação direta. Realizou-se a busca de artigos que abordavam o tema na base de dado SciELO com os descritores: câncer bucal; neoplasias de glândulas salivares; carcinoma de células escamosas; quimioterapia; radioterapia. Os artigos foram classificados quanto à evidência científica que a ordem crescente do Grau de Evidência Científica (GEC) é: Opinião de Experts e Relato de Caso (GEC1); Estudo Experimental de Caso Único/ Série de Casos (GEC2), Estudos Descritivos (GEC3); Estudos Quase-experimentais (GEC4); Estudo Caso-Controle (GEC5); Estudo Coorte (GEC6); Ensaio Clínico Aleatório (GEC7); Revisão Sistemática com Metanálise ou sem (GEC8). Foi coletado também à área de conhecimento do artigo. RESULTADOS: A partir da análise de 150 artigos, foi identificado o GEC das publicações, sendo GEC1: 30,0% (n=45), GEC2: 8,0% (n=12), GEC3: 47,3% (n=71), GEC4: 4,0% (n=6), GEC5: 2,6% (n=4), GEC6: 6,6% (n=10), GEC7: 0,6% (n=1), GEC8: 0,6% (n=1). Quanto a área de conhecimento do artigo temos, tratamento: 38,6% (n=58); diagnóstico: 33,3% (n=50); epidemiologia: 19,3% (n=29); prevenção: 4,6% (n=7) e prognóstico: 4,0% (n=6). CONCLUSÃO: Os artigos analisados possuem pequena força de evidência, concentrando-se em Estudo Descritivo (GEC3) e na área do tratamento de câncer bucal

OBJECTIVE: To evaluate the scientific evidence level of articles indexed in the SciELO database addressing oral cancer, from 2001 to 2011. MATERIAL AND METHODS: It was used an inductive approach, with descriptive statistical procedures, and direct documentation technique. Were conducted searches for articles that addressed the topic in SciELO database by using the descriptors: oral cancer, salivary gland neoplasms, squamous cell carcinoma, chemotherapy; radiotherapy. The articles were classified according to scientific evidence stated by the increasing degree of Scientific Evidence (GEC): Expert Opinion and Case Report (GEC1); Single Case Experimental Study / Case Series (GEC2); Descriptive Studies (GEC3); Quasi-experimental studies (GEC4); Case-Control Study (GEC5); Cohort Study (GEC6); Randomized Clinical Trial (GEC7); Systematic Review with or without Meta-analysis (GEC8). It was also collected the of knowledge related to the article. RESULTS: From the analyses of 150 papers, it was identified the GEC for the publications, as follows: GEC1: 30.0% (n=45); GEC2: 8.0% (n=12); GEC3: 47.3% (n=71); GEC4: 4.0% (n=6); GEC5: 2.6% (n=4); GEC6: 6.6% (n=10); GEC7: 0.6% (n=1); and GEC8: 0.6% (n=1). As regards the of knowledge, it was found: treatment: 38.6% (n=58); diagnosis: 33.3% (n=50); epidemiology: 19.3% (n=29); prevention: 4.6 % (n=7) and prognosis: 4.0% (n=6). CONCLUSION: The articles analyzed have small force of evidence, focusing on descriptive study (GEC3) and on oral cancer treatment.

Programa de saúde bucal domiciliar para crianças e adolescentes com paralisia cerebral / Oral health home program for children and teenagers with cerebral palsy

Objetivo: avaliar um programa de cuidado em Saúde Bucal (SB) domiciliar para Crianças e Adolescentes com Paralisia Cerebral (CAPC) e seus cuidadores. Metodologia: estudo de Intervenção com ensaio clínico não controlado. A amostra compreendeu 12 CAPC entre 2-16 anos e 12 cuidadores. O programa preventivo domiciliar constou de ações individuais semanais. As ações foram planejadas a partir dos dados coletados nos exames clínicos nas CAPC, antes da implantação do programa. O cuidador recebeu noções de educação em saúde e treinamento para Escovação Supervisionada (ES) adaptada com abridores de boca. As CAPC receberam ações de ES, aplicação tópica de flúor, raspagem periodontal supragengival e Tratamento Restaurador Atraumático. O exame clínico registrou, por examinador calibrado (Kappa 0,88), o Índice de Higiene Oral Simplificado (IHOS), Índice de Sangramento Gengival (ISG), Dentes Perdidos, Cariados e Obturados (CPOD) e dentes decíduos cariados, extraídos e obturados (ceo-d) analisados pelo teste Wilcoxon (alfa=0,05). O programa foi avaliado pela comparação entre os dados coletados antes (t0) e após três meses (t1) de implantação do programa. Resultados: Foram realizadas 94 consultas domiciliares, no período de agosto a outubro de 2011. Os resultados do IHOS médio (t0 = 2,26±0,43; t1= 0,62±0,32) e do ISG médio (t0= 19,3±7,68; t1= 4,0±3,39) apresentaram diferença significativa (p0,005). O componente cariado do ceo-d (t0= 1,08±2,27; t1= 0,0±0,0) foi revertido em obturado (t0= 0,34±1,15; t1= 1,42±2,67). Os componentes Cariado (0,0±0,0), Perdido (0,0±0,0) e Obturado (0,5±1,73) do CPO-D e extraído (0,58±2,02) do ceo-d não foram alterados entre t0 e t1. Conclusão: O programa domiciliar avaliado qualificou o cuidado em SB das CAPC e produziu alterações positivas dos índices bucais.

Objective: To evaluate an oral health (OH) home program for children and teenagers with cerebral palsy (CTCP) and for their respective caregivers. Methods: This was an interventional study with non-controlled clinical trial. The sample consisted of 12 CTCP aged 2 to 16 years and 12 caregivers. The preventive home program consisted of weekly individual interventions. Actions were planned according to data collected in the clinical examinations of the CTCP before implementing the program. Caregivers were instructed as regards health education and training for supervised tooth brushing (STB) adapted with mouth openers. The CTCP underwent STB, fluoride topical application, supragingival scaling and Atraumatic Restorative Treatment. On clinical examination, a calibrated examiner (Kappa 0.88) registered the simplified Oral Hygiene Index (S-OHI); Gingival Bleeding Index (GBI); decayed, missing and filled teeth (DMFT) and decayed, extracted and filled primary teeth (def), which were analyzed by the Wilcoxon test (alpha=0.05). The program was assessed by comparing data collected at baseline (t0) and after three months (t1) upon its implementation. Results: 94 home consultations were performed from August to October 2011. S-OHI mean (t0 = 2.26±0.43; t1= 0.62±0.32) and GBI mean (t0= 19.3±7.68; t1= 4.0±3.39) were found to present significant difference (p0.005). The 'decayed' component of def (t0= 1.08±2.27; t1= 0.0±0.0) turned into 'filled' (t0= 0.34±1.15; t1= 1.42±2.67). The 'decayed' (0.0±0.0), 'missing' (0.0±0.0) and 'filled' (0.5±1.73) components of DMFT and the 'extracted' component of def did not differ significantly between t0 and t1. Conclusion: The assessed home program provided OH care for CTCP and resulted in positive changes of the oral indexes.

Antifungal activity of plant-based tinctures on Candidas

Objective: To evaluate through determination of minimum inhibitory concentration (MIC) the antifungal activity of Salvia officinalis (sage), Anacardium occidentale (cashew) and Malva sylvestris (mallow) tinctures on Candida albicans (ATCC 40227), C. tropicalis (ATCC 13803) and C. krusei (ATCC 40147). Material and methods: In 96-well microplates, 100 μl of Sabouraud-Dextrose broth doubly concentrated, 100 μl of the tested tinctures and 10 μl of fungal inoculums (1.5 x 106 organisms/ml) were inserted. The products were diluted from initial concentration of 100 mg/ml until 0.78 mg/ml. MIC corresponded to the lowest dilution at which there was no visible fungal growth. Nystatin (100,000 UI/ml) was used as control. Statistical analysis was performed by Kruskal-Wallis and Dunn tests (p < 0.05). Results: S. officinalis tincture did not inhibit the growth of C. albicans and C. tropicalis; MIC was 100 mg/ml for C. krusei. For A. occidentale, MIC was 100 mg/ml for C. albicans and C. krusei, and for C. tropicalis, there was no fungal inhibition. M. sylvestris tincture presented MIC at 25 mg/ml for C. krusei and 100 mg/ml for C. albicans and C. tropicalis. The best antifungal activity was showed by M. sylvestris tincture (p < 0.05). Conclusion: M. sylvestris tincture exhibited antifungal activity against all the tested strains at lower concentrations. S. officinalis tincture inhibited the action of C. krusei and A. occidentale tincture showed activity against C. albicans and C. tropicalis.

Levantamento das Jurisprudências de Processos de Responsabilidade Civil Contra Cirurgiões-Dentistas nos Tribunais de Justiça Brasileiros / Jurisprudence’ Survey of Civil Liability Cases Against Dentists in Brazilian Courts of Justice

Realizar o levantamento das jurisprudências deresponsabilidade civil promovidas pelo paciente contra oCirurgião-Dentista (CD) nos estados brasileiros no período entre2006 e 2011. Material e Métodos: Os dados foram coletadosnos sites dos Tribunais da Justiça de cada estado, sendorelativos à obrigação assumida, ao seu fundamento, ao agentee as especialidades mais emanadas. Realizou-se o cálculo daexperiência processual a partir do número de processos pornúmero de CDs inscritos nos Conselhos Federal e Regionais,procedendo-se a análise descritiva. Resultados: Foramlevantadas 1046 jurisprudências, com São Paulo e Rio deJaneiro apresentando os maiores números de processos.Quanto ao tipo de obrigação do CD, 9,51% consideraram anatureza de resultado, enquanto em 77,57% essa informaçãonão foi citada. A responsabilidade do CD foi definida comosubjetiva em 14,31% das jurisprudências, mas em 70,33% amesma não foi classificada. O coeficiente de experiênciaprocessual brasileiro foi de 4,23 e os estados que demonstraramos maiores valores foram: Rio de Janeiro (11,75) e DistritoFederal (6,81). Em relação às especialidades odontológicas,as mais citadas foram implantodontia (11,53%) e prótese (9,3%).Conclusão: O coeficiente de experiência processual brasileiroé alto e, apesar da ausência de informações em parte dasjurisprudências, percebe-se que a responsabilidade docirurgião-dentista normalmente é interpretada como subjetiva,de origem contratual, com obrigação de resultado...

To survey the case law of civil liability undertakenby patients against dentists in Brazilian states between 2006and 2011. Material and Methods: Data were collected fromwebsites of the Courts of Justice of each state, taking intoaccount: obligation’ nature, its ground, the agent and dentalspecialties more involved. We carried out the calculation ofcoefficient of legal experience by dividing the number of casesper number of dentists registered at Federal and RegionalCouncils. Then, descriptive analysis was conducted. Results:The sample comprised 1046 jurisprudence and Sao Pauloand Rio de Janeiro showed the highest numbers of cases.Regarding the type of obligation assumed by dentists, 9.51%considered the result as the final aim of dentist-patient relation,while in 77.57% this information was not cited. Dentist’sresponsibility was defined as subjective in 14.31% ofjurisprudence, but in 70.33% it was not classified. The Braziliancoefficient of legal experience was 4.23 and the states thatshowed the highest values †were Rio de Janeiro (11.75) andthe Federal District (6.81). Regarding dental specialties, dentalimplants (11.53%) and prosthetics (9.3%) were the most cited.Conclusion: The Brazilian coefficient of legal experience ishigh and, despite the lack of information on some jurisprudence,it is clear that the responsibility of the dentist is usuallyinterpreted as subjective, as source contract, with an obligationof result...

Impacto de Programa de Promoção em Saúde Bucal para Cuidadores e Crianças com Paralisia Cerebral / Impact of Oral Health Promotion Program for Caregivers and Children with Cerebral Palsy

Objetivo: Relatar o efeito de um programa de promoção em Saúde Bucal para crianças com Paralisia Cerebral (PC) e cuidadores.Método: Estudo de intervenção com ensaio clínico não controlado, realizado nos domicílios de 10 crianças (3-13 anos) com PC e seus cuidadores, identificadas nas unidades de saúde de João Pessoa/PB. Entrevista com cuidador e exame clínico da criança com registro do Índice de Higiene Oral Simplificado (IHOS) foram realizados antes e após programa. Na entrevista foram coletados hábitos alimentares e de higiene bucal. No exame clínico foi registrado o IHOS por examinador calibrado (Kappa = 0,85). Por 90 dias foram realizadas visitas semanais, com ações educativas, individualizadas e planejadas a partir dos dados da entrevista inicial (E1); trabalho da técnica de escovação feita pelo cuidador na criança, com orientação, demonstração e supervisão; e fluorterapia. Na avaliação, foi feito uma nova entrevista (E2) e exames bucais. A análise estatística utilizou o Teste t de Student, sendo adotado um nível de significância de 5%.Resultados: Hábitos alimentares, em E1: o utensílio era mamadeira (7), ofertavam açúcar em excesso (10), e todas as dietas pastosas incluíam açúcar (8). Em E2: o utensílio foi copo/colher (8), ofertavam açúcar em excesso (zero), recebiam dietas pastosas e fibrosas sem açúcar (8). Hábitos de higiene, em E1: gaze e colutório exclusivo, uma vez ao dia (1); sem técnica de escovação, uma vez ao dia (9). Em E2: uso de gaze com colutório semanal (1), técnica satisfatória de escovação, duas vezes ao dia (10). O IHOS médio no primeiro exame foi 2,63 e no segundo 0,91, com diferença estatisticamente significante (p<0,01).Conclusão: O cuidado de Saúde Bucal das crianças com PC foi alterado e as ações produziram mudanças positivas nos hábito de higiene e alimentação, bem como na quantidade de biofilme

Objective: To report the effect of an oral health promotion program for children with cerebral palsy and their caregivers.Method: An interventional study with non-controlled clinical trial was performed in the homes of 10 children (3-13 years) with cerebral palsy and their caregivers, identified at the Public Health Units of João Pessoa, PB, Brazil. Before and after the program, the caregivers were interviewed and the children were subjected to clinical exam and application of the Simplified Oral Hygiene Index (OHI-S). Information on dietary habits and oral hygiene was collected during the interview. The OHI-S was recorded by a calibrated examiner (Kappa = 0.85) in the clinical exam. During 90 days, weekly visits were carried out involving individualized educative actions planned from the data collected in the initial interview (I1) with the caregivers; working on the toothbrushing technique used by the caregiver in the child, comprising orientation, demonstration and supervision; and fluoride therapy. After the program, a new interview (I2) and a new clinical exam were performed.

The statistical analysis used the StudentÆs t-test at a significance level of 5%. Results: Dietary habits, in I1: a bottle feeding was used (7); offered of sugar in excess (10); and all pasty diets included sugar (8). In I2: a glass/spoon was used (8); offered sugar in excess (0), offered pasty and fibrous diets without sugar (8). Hygiene habits, in I1: gaze and mouthwash exclusivo (?), once a day (1); no toothbrushing technique, once a day (9). In I2: use of gauze soaked with mouthwash once a week (1), satisfactory toothbrushing technique, twice a day (10). The mean OHI-S was 2.63 in the first exam and 0.91 in the second exam, with statistically significant difference between them (p<0.01).Conclusion: Oral health care of children with cerebral palsy was altered and the actions produced positive changes in the hygiene and dietary habits as well as in the amount of dental biofilm

Atividade Antifúngica de Antissépticos Bucais sobre candida spp / Antifungal Activity of Mouthwashes on Candida spp

Verificar a atividade antifúngica in vitro dosantissépticos bucais Malvatricim® (P1), Colgate Plax® (P2),Oral B® (P3), Colgate Periogard® (P4) sobre Candidaalbicans (ATCC 40277), Candida albicans (ATCC 289065),Candida krusei (ATCC 40147), Candida tropicalis (ATCC13803) e Candida tropicalis (ATCC 40042). Material eMétodo: Foram confeccionadas suspensões fúngicas(concentração de 106 microrganismos/mL), as quais foramsemeadas em placas com Ágar Sabouraund Dextrose 4%.Realizou-se o teste de difusão em ágar, utilizando-se ametodologia dos poços, nos quais foram inseridos 50μL dosprodutos em sua formulação comercial. Como controlepositivo, utilizou-se a Nistatina 1:100.000 UI (P5). As placasforam incubadas em estufa bacteriológica a 37ºC por 48h.Os testes foram realizados em triplicata e comparados aocontrole positivo. O diâmetro médio dos halos de inibição docrescimento (DMIC) produzidos pelas substâncias foicalculado e representou a ação antimicrobiana. Resultado:Frente a C. albicans (ATCC-289065), C. krusei (ATCC-40147), C. tropicalis (ATCC-40042), e C. tropicalis (ATCC-13803) o P4 teve melhor atuação com DMIC de 15,0mm;15,0mm, 18,0mm e 14,3mm, respectivamente. A cepa de C.albicans (ATCC-40277) foi a única susceptível a P1(DMIC=25,3mm) e resistente a P5. Os colutórios P2, P3 e P4apresentaram atividade antimicrobiana sobre todas as cepastestadas. Conclusão: Concluiu-se que os produtos testados,a exceção do Malvatricim®, apresentaram atividade inibitóriasobre todas as cepas analisadas. O Colgate Periogard®apresentou melhor atividade diante das cepas investigadas,seguido por Colgate Plax®, Oral B® e Malvatricim®...

To verify the in vitro antifungal activity of themouthwashes Malvatricim® (P1), Colgate Plax® (P2), Oral B®(P3) and Colgate Periogard® (P4) on Candida albicans (ATCC40277), Candida albicans (ATCC 289065), Candida krusei(ATCC 40147), Candida tropicalis (ATCC 13803) and Candidatropicalis (ATCC 40042). Material and Methods: Fungalsuspensions were prepared (106 microrganisms / mL) andseeded on Petri dishes containing Sabouraud Dextrose Agar4%. It was followed the agar diffusion method by means ofthe Wells technique. Into each well were inserted 50 μL ofthe products as in their commercial formulation. Nystatin1:100.000 IU (P5) was used as positive control. The plateswere incubated in bacteriological incubator at 37ºC for 48h.Tests were performed in triplicate and compared to positivecontrol. The mean diameter of growth inhibition halos (MDGI)promoted by the substances was calculated and representedthe antimicrobial activity. Results: P4 has showed the mostpotent activity against C. albicans (ATCC-289065), C. krusei(ATCC-40147), C. tropicalis (ATCC-40042), and C. tropicalis(ATCC-13803), with MDGI of 15.0mm; 15.0mm; 18.0mm and14.3mm, respectively. C. albicans strain (ATCC-40277) wasthe only one susceptible to P1 (MDGI=25.3mm) and resistantto P5. The mouthwashes P2, P3 and P4 have presentedantimicrobial activity against all strains assessed. Conclusion:It is concluded that the products under study, exceptingMalvatricim®, have showed inhibitory activity on all strainsassayed. Colgate Periogard® has presented the best activityon the strains investigated, followed by Colgate Plax®, OralB® and Malvatricim®...

O acesso ao cuidado em saúde bucal para crianças com deficiência motora: perspectivas dos cuidadores / Access to oral health care for children with motor disability: caregivers' perspectives

Objetivo: Avaliar o acesso e identificar as barreiras ao cuidado em Saúde Bucal de Crianças com Deficiência Motora (CDM) em João Pessoa - PB, a partir das perspectivas de seus cuidadores. Metodologia: Utilizou-se abordagem indutiva, procedimento descritivo e técnica de observação direta intensiva, por meio de entrevista. Participaram do estudo 43 dos 59 cuidadores de CDM de 0-12 anos identificados, selecionados por conveniência. As entrevistas, gravadas em áudio, foram transcritas e analisadas descritivamente e qualitativamente (técnica do Discurso do Sujeito Coletivo - DSC). Resultados: Segundo relato dos cuidadores, o diagnóstico das crianças foi Paralisia Cerebral (86%; n=36), Hidrocefalia (4%; n=2), Mielomenigocele (2%; n=2), Síndrome de West (2%; n=1), Síndrome de Down (2%; n=1) e Síndrome de Rett (2%; n=1). O acesso ao dentista foi obtido por 69% (n=30) das crianças, sendo 50% (n=15) no setor privado. Dificuldades para obter o acesso foram encontradas por 65% (n=28), entre elas, baixa oferta de dentistas para atender pacientes especiais (75%; n=21), demora no agendamento (18%; n=5) e indisponibilidade de realizar o procedimento com anestesia geral (7%; n=2). O DSC obtido da percepção sobre o cuidado em saúde bucal foi: O cuidado em Saúde Bucal é medidas de prevenção, promoção e controle, através da higienização e eliminação de hábitos deletérios, além do acompanhamento periódico com o dentista. Conclusão: A partir da percepção do cuidador, o acesso ao cuidado em saúde bucal das CDM é difícil, apresentando como barreiras: baixa oferta de dentistas para atender pacientes especiais, demora no agendamento e necessidade de anestesia geral.

Objective: To evaluate the access and identify obstacles for oral health care of Children with Motor Disability (CMD) in the city of Joao Pessoa - PB, from caregivers' perspectives. Methods: It was employed an inductive approach, descriptive procedure and intensive direct observation technique by means of interview. The study encompassed 43 out of the 59 caregivers of identified CMD aged 0-12 years, selected by convenience. Audio-recorded interviews were transcripted and analyzed descriptively and qualitatively (Collective Subject Discourse technique - CSD). Results: According to caregivers' reports, children's diagnoses were cerebral palsy (86%; n=36), hydrocephaly (4%; n=2), spina bifida (2%; n=2); West syndrome (2%; n=1), Down syndrome (2%; n=1) and Rett syndrome (2%; n=1). The access to dentist was achieved by 69% (n=30) children, from which 50% (n=15) was in the private practice. Difficulties in getting access were found by 65% (n=28); among those, are: low supply of dentists to support disabled patients (75%; n=21), delay in scheduling (18%; n=5) and unavailability to perform the procedure without general anesthesia (7%; n=2). The CSD gathered from the perception on oral health was: Oral health care is measures for prevention, promotion and control, through cleansing and elimination of harmful habits, besides being a regular follow-up by the dentist. Conclusion: From the caregiver's perception, access to oral health care by CMD is hard, presenting as obstacles: low supply of dentists to support disabled patients, delay in scheduling and need for general anesthesia.