Prevalence of dental caries, periodontal disease, malocclusion, and tooth wear in indigenous populations in Brazil: a systematic review and meta-analysis

Abstract The aim of this review was to evaluate the prevalence of dental caries, periodontal disease, malocclusion, and tooth wear in indigenous in Brazil. A systematic review of observational studies was performed according to the PRISMA guidelines (CRD42020218704). The search strategy involved the electronic databases of Embase, LILACS, PubMed, Web of Science, Scopus, and the CAPES Theses and Dissertations for gray literature. The eligibility criteria consisted of publications that assessed the prevalence of oral conditions in indigenous populations in Brazil. Studies with indigenous people living in urban area were excluded. The risk of bias was evaluated by using JBI Critical Appraisal for prevalence studies. Thirty studies were included in the review, and the majority showed a low risk of bias. A meta-analysis of 20 studies was conducted using the random-effects model and a 95% confidence interval. Several ethnicities were studied in isolation or in groups (n = 7,627 for dental caries; n = 2,774 for periodontal disease; n = 1,067 for malocclusion; n = 150 for tooth wear). The prevalence of caries ranged from 50% among indigenous people aged 18-36 months to 100% among those aged 65-74 years. The prevalence of periodontal disease ranged from 58% to 83%. The prevalence of malocclusion was 43%. Tooth wear was assessed in only one ethnic group and showed a prevalence of 100% in indigenous people aged >18 years. The certainty of evidence assessed by the GRADE system ranged from very low to moderate. This systematic review showed significant differences in the prevalence of dental caries, periodontal disease and malocclusion between indigenous population groups and territories in which indigenous people live.

Parents' sense of coherence in the use of dental services by children aged 12 years old in the city Manaus/AM

Aim The aim of this study was to evaluate the association between the sense of coherence (SOC) of parents/guardians and the use of dental services by children who are 12 years old. Methods This is a cross-sectional study conducted in the eastern zone of the city of Manaus, with 358 children enrolled in the 7th grade in the municipal public school system. Data collection was performed through self-administered questionnaires sent to parents/guardians, which contained questions about socioeconomic conditions, use of dental services by children and Antonovsky's SOC-13 scale. Data were examined by descriptive and bivariate analysis, using the Chi-square test, with a 5% significance level. Results Of the 358 children, 58.4% were female; in addition, 75.4% of the parents/guardians self-reported to be brown and 39.9% of them had a family income of ½ to 1 minimum wage. SOC was categorized as strong SOC and weak SOC by the median. The association between strong or weak SOC and the use of dental services in terms of frequency (p= 0.839) and reason for last visit (p= 0.384), was not significant. Conclusion It was concluded that SOC of parents/guardians and utilization of dental services by children were not associated.

Fluoride Concentration in Public Water Supply in a City in the Amazon Region

Abstract Objective: To analyze the fluoride concentration in the public water supply in Manaus, Brazil. Material and Methods: Water samples were collected in 50 mL polyethylene bottles, identified, and labeled. The collection was performed from September 2016 to August 2018. For the selection of collection points, all neighborhoods of the city of Manaus, divided into four health districts (North, South, East, and West), were mapped. From each district, 30 samples were collected, totaling 120 monthly samples. Water samples were analyzed using an ion analyzer, ORION 720-A, and a specific electrode, ORION 96-09. The ion analyzer and electrode were calibrated in standard solutions. The levels were classified in intervals based on technical consensus to guide the health surveillance agencies. Results: Of the 2,874 water samples, 50.3% were within the recommended range, and 49.7% were inadequate, with 31.6% considered above the parameters and 18.1% below. Among the districts, the North had the highest percentages of unsatisfactory samples, resulting in limited action to prevent tooth decay. During the 24 months of analysis, there were large oscillations in the values in all four districts of Manaus. Conclusion: Results reinforce the importance of heterocontrol for the city to guarantee the effectiveness of this public health measure.

The influence of protective psychosocial factors on the incidence of dental pain / A influência de fatores psicossociais protetores sobre a incidência de dor dentária

ABSTRACT OBJECTIVE To investigate the influence of protective psychosocial factors on the incidence of dental pain in the last six months among 12-year-old children living in Manaus (AM). METHODS A prospective school-based cohort study was conducted with 210 12-year-old students enrolled in public schools in the eastern zone of Manaus (AM). Students were followed up for two years. Validated questionnaires were used to assess sociodemographic characteristics, protective psychosocial factors, including sense of coherence, social support, and self-esteem at baseline and after two years. Calibrated examiners clinically assessed dental caries and gingival bleeding. Multivariate multilevel Poisson regression was used to estimate the relative risk (RR) and 95% confidence interval (95%CI) between the changes on psychosocial factors scores and incidence of dental pain, adjusted for psychosocial factors scores at baseline, dental health insurance, frequency of tooth brushing, and dental caries. RESULTS Mean scores for sense of coherence and social support reduced significantly from baseline to 2-year follow-up. The incidence of dental pain along the two-year follow-up was 28.6%. The risk of dental pain was 14% higher for every 10 points in the mean reduction of sense of coherence score (RR = 1.14; 95%CI: 1.02-1.20), and 6% higher for every 10 points of the mean reduction in social support score (RR = 1.06; 95%CI: 1.01-1.11). Change on self-esteem was not associated with risk of dental pain. CONCLUSION Change on sense of coherence and social support over the two-year period influenced the incidence of dental pain among children, suggesting that protective psychosocial factors, health behaviours, dental health insurance, and clinical oral condition have an important role in the incidence of dental pain.

RESUMO OBJETIVO Investigar a influência de fatores psicossociais protetores sobre a incidência de dor dentária nos últimos seis meses em crianças de 12 anos residentes em Manaus (AM). MÉTODOS Um estudo de coorte prospectivo de base escolar foi realizado com 210 alunos de 12 anos, matriculados em escolas públicas da zona leste de Manaus (AM) que foram acompanhados por dois anos. Questionários validados foram usados para avaliar características sociodemográficas, fatores psicossociais protetores, incluindo senso de coerência, apoio social e autoestima na linha de base e após dois anos. Examinadores calibrados avaliaram clinicamente cárie dentária e sangramento gengival. Regressão de Poisson multinível multivariada foi usada para estimar o risco relativo (RR) e o intervalo de confiança de 95% (IC95%) entre a variação dos escores dos fatores psicossociais e a incidência de dor dentária, ajustada para os escores dos fatores psicossociais na linha de base, plano de saúde odontológico, frequência de escovação dentária e cárie dentária. RESULTADOS As médias dos escores do senso de coerência e do apoio social reduziram significativamente entre linha de base e seguimento de dois anos. A incidência de dor dentária no seguimento de dois anos foi 28,6%. O risco de dor dentária foi 14% maior para cada 10 pontos na redução média do escore do senso de coerência (RR = 1,14; IC95% 1,02-1,20), e 6% maior para cada 10 pontos na redução média do escore do apoio social (RR = 1,06; IC95% 1,01-1,11). A mudança na autoestima não foi associada ao risco de dor dentária. CONCLUSÃO A variação do senso de coerência e do apoio social no período de dois anos influenciou a incidência de dor dentária em crianças, sugerindo que fatores psicossociais protetores, comportamentos em saúde, plano odontológico e a condição clínica bucal desempenham um papel importante na incidência da dor dentária.

Fluoride toothpaste, sanitary surveillance and the SUS: the case of Manaus-AM, Brazil / Dentifrício fluoretado, vigilância sanitária e o SUS: o caso de Manaus-AM

ABSTRACT OBJECTIVE To determine the anticaries potential of toothpastes distributed by the primary health care public clinics (UBS) of Manaus, AM. METHODS Ninety-nine tubes of toothpaste from four commercial brands were collected from October 7, 2019 to October 11, 2019 in 16 UBS. They were assigned a code by brand and source UBS. According to the information on the packaging, the four brands and their batches were formulated with sodium monofluorophosphate (Na2FPO3) and most (91%) had calcium carbonate (CaCO3) as an abrasive. We determined the concentrations of total fluoride (TF = TSF + InsF) and total soluble fluoride (TSF = F ions- or FPO32-), to certify whether they were in compliance with resolution ANVISA RDC No. 530 (maximum of 1,500 ppm TF) and whether they had anticaries potential (minimum of 1,000 ppm TSF). The analyses were performed with a ion- specific electrode. RESULTS The concentrations (ppm F) of TF [mean; standard deviation (SD); n] found in toothpaste brands A (1,502.3; SD = 45.6; n = 33), B (1,135.5; SD = 52.7; n = 48) and D (936.8; SD = 20.5; N = 8) were close to those stated on the package, 1,500, 1,100 and 1,000 ppm F, respectively. In toothpaste C, we found a mean of 274.1 ppm (SD = 219.7; n = 10) of TF, which diverges from the declared concentration of 1,500 ppm F. In addition, the five tubes of lot no. 11681118 of toothpaste C did not contain fluoride. Regarding TSF, with the exception of toothpaste D (937.9; SD = 40.29), the others had a lower concentration than their respective TF. CONCLUSION We found serious problems of quantity and quality of fluoride in toothpaste distributed by the SUS in Manaus, which shows the need for surveillance of these products and confirms the urgency of revising resolution RDC No. 530.

RESUMO OBJETIVO Determinar o potencial anticárie dos dentifrícios distribuídos pelas unidades básicas de saúde (UBS) de Manaus-AM. MÉTODOS Noventa e nove bisnagas de dentifrícios de quatro marcas comerciais foram coletadas de 7 de outubro de 2019 a 11 de outubro de 2019 em 16 UBS, que foram codificados por marca e UBS de origem. De acordo com a embalagem, os dentifrícios das quatro marcas e seus lotes foram formulados com monofluorofosfato de sódio (Na2FPO3) e a maioria (91%) tinha carbonato de cálcio (CaCO3) como abrasivo. Foram determinadas as concentrações de fluoreto total (FT = FST + Fins) e de fluoreto solúvel total (FST = íons F- ou FPO32-), para certificar se atendiam à resolução ANVISA RDC Nº 530 (máximo de 1.500 ppm de FT) e se tinham potencial anticárie (mínimo de 1.000 ppm de FST). As análises foram feitas com eletrodo íon específico. RESULTADOS As concentrações (ppm F) de FT [média; desvio padrão (DP); n] encontradas nos dentifrícios A (1.502,3; DP = 45,6; n = 33), B (1.135,5; DP = 52,7; n = 48) e D (936,8; DP = 20,5; n = 8) foram próximas ao descrito na embalagem, 1.500, 1.100 e 1.000 ppm F, respectivamente. No dentifrício C, foi encontrada média de 274,1 ppm (DP = 219,7; n = 10) de FT, divergindo da concentração declarada de 1.500 ppm F. Em acréscimo, as cinco bisnagas do lote no 11681118 do dentifrício C não foram fluoretadas. Quanto ao FST, à exceção do dentifrício D (937,9; DP = 40,29), os demais apresentaram concentração inferior ao seu respectivo FT. CONCLUSÃO Observou-se problemas graves de quantidade e qualidade do fluoreto nos dentifrícios distribuídos pelo SUS em Manaus, mostrando a necessidade de vigilância desses produtos e ratificando a urgência da revisão da resolução ANVISA RDC Nº 530.

Construção de um indicador multidimensional de saúde bucal para a população idosa da cidade de Manaus, AM / Construction of a multidimensional oral health indicator for the older population in the city of Manaus-Amazonas

Resumo Objetivo Produzir um indicador multidimensional de saúde bucal, a partir de variáveis dentárias e não dentárias, para a pessoa idosa da zona urbana do município de Manaus, AM, Brasil. Método Os dados utilizados são oriundos de um estudo transversal de base populacional conduzido no ano de 2008, com indivíduos de 65 a 74 anos de idade, aleatoriamente selecionados, residentes na cidade de Manaus. Para a produção do indicador proposto, consideraram-se as variáveis dentárias (CPO-D - Índice de Dentes Perdidos, Cariados e Obturados; CPI - Índice Periodontal Comunitário; PIP- Índice de Perda de Inserção Periodontal) e não dentárias (socioeconômicas e índice GOHAI - General Oral Health Assessment Index). Uma Análise Fatorial Exploratória sintetizou essas variáveis, facilitando a construção do indicador multidimensional. Resultados A análise gerou três fatores que, em conjunto, explicaram 72,9% da variância do modelo (KMO = 0,749 e p< 0,001 para o teste de esfericidade de Bartlett). Esses três fatores foram reduzidos à variável "soma", calculada a partir da soma dos escores fatoriais por indivíduo. A mediana dessa nova variável foi o valor de referência para categorização da condição de saúde bucal do indivíduo em "favorável" ou "desfavorável". Conclusão O indicador foi capaz de agregar diversas dimensões da saúde bucal em uma única medida, além de possibilitar sua reprodutibilidade para construção de outros indicadores de saúde.

Abstract Objective Produce a multidimensional indicator of oral health, based on dental and non-dental variables, for the older adult in the urban area of the city of Manaus-AM. Method The data used are from a cross-sectional population-based study conducted in 2008 with randomly selected individuals aged 65 to 74 years, residing in the city of Manaus. To produce the proposed indicator, the dental variables (DMFT- Decayed, Missing and Filled Teeth; CPI- Community Periodontal Index; PIP- Periodontal Insertion Loss Index) and non-dental (socioeconomic and index GOHAI- General Oral Health Assessment Index) were considered. An exploratory factor analysis synthesized these variables, facilitating the construction of the multidimensional indicator Results The analysis generated three factors that, together, explained 72.9% of the model's variance (KMO = 0.749 and p<0.001 for Bartlett's test of sphericity). These three factors were reduced to the "sum" variable, calculated from the sum of the factor scores per individual. The median of this new variable was the reference value for categorizing the individual's oral health condition into "favorable" or "unfavorable". Conclusion The indicator was able to aggregate several dimensions of oral health into a single measure, in addition to enabling its reproducibility for the construction of other health status indicators.

Need of Dental Prosthesis in Older People and the Offer of Specialized Care in the Unified Health System, Brazil

Objective: To analyze the offer of dental prosthesis by Centers of Dental Specialties (CEO) considering the need by individuals aged 65-74 years in state capitals and other regions of the country. Material and Methods: The study was conducted with data from the external evaluation of the Improving Access and Quality Program (AVE/PMAQ CEO) and with data from the SBBRASIL 2010 project. AVE / PMAQ CEO is an evaluative investigation using a cross-sectional research design, performed in all CEOs of Brazil, totaling 932 services evaluated. The analysis of data and distribution of CEOs that offered dental prosthesis was described by maps, using TabWin (DATASUS) and quantitative description of the following variables: need for total and partial dentures, CEO, Regional Prosthodontic Laboratories (RLDP), average monthly number of delivered prostheses and the proportion of capitals with RLDP, number of CEOs, RLDP and prostheses delivered per 100,000 inhabitants in state capitals and other regions. Results: Of the 5,570 municipalities in the country, 780 have CEO, mainly located on municipalities with larger populations. Most CEOs were located in the northeastern (38.3%) and southeastern regions of Brazil (36.2%) with the northern and mid-western regions presenting the lowest absolute number of units. Low offer of prostheses was observed, considering the high need of dentures, as well as an unequal distribution among Brazilian regions. A high percentage of older adults aged 65-74 years require total (74.6%) or partial (99.8%) prosthetic rehabilitation, more critical situation is observed in the northern and northeastern regions. Conclusion: The provision of dental services in CEOs is still limited and unevenly distributed, especially for PPR, compromising the universality and integrality of oral health care.

Equity in the Accessibility to Specialized Care in Oral Health in Brazil: Analysis of PMAQ-CEO External Evaluation Data According to the User's Perspective

Objective: To analyze the distribution of Centers of Dental Specialties (CEO) implemented in Brazil until 2014 and identify the contextual and individual variables associated with the geographical accessibility, considering the user's perspective. Material and Methods: The study was conducted with data from the Improving Access and Quality of CEOs (AVE/PMAQ CEO) External Evaluation and contextual characteristics of states and municipalities. The AVE/PMAQ CEO was an evaluative research with cross-sectional observational character, performed in all CEOs in Brazil, with 932 services evaluated and 8,897 users interviewed. Data analysis was conducted in two stages, considering the study dimensions. Analyses were conducted on the availability of units by region, state, population size of the municipality and contextual variables. Then, the relationship between explanatory variables and the user's displacement time and with the intention to change the service location was evaluated using generalized linear regression analysis. Results: The 932 CEOs evaluated were located in 780 of the 5,570 municipalities of the country and the majority was located in the northeastern (38.3%) and southeastern regions (36.2%), with the northern and midwestern regions presenting the lowest absolute number of units. The average displacement time to the CEO was 28.4 minutes, while the intention to change CEO location due to the distance from home was reported by 7.8% of users. Lower geographical accessibility was reported in the northern region and for individuals who reported living in the rural area and in cities with larger populations. Conclusion: The availability of CEOs in the country is still low and not equitably distributed among states and regions.

Effect of Chewing Gum Containing CPP-ACP on Salivary Flow and Buffer Capacity: An in vivo Study

Objective: To evaluate salivary flow and buffer capacity by means of mechanical and chemical-mechanical stimuli, through the use of chewing gums. Material and Methods: The study was a cross-sectional study with 12 volunteers, divided into three groups, in three phases: Group A: paraffin gum; Group B: Chewing gum without sucrose, flavored (Trident®); Group C: Flavored chewing gum, without sucrose and amorphous calcium casein-phosphate phosphopeptide (Trident Total®). The stimulated total saliva was collected after 5 minutes of mastication of one of the products and the volume was expressed in mL / min. The same sample was submitted to pH measurement with the use of a digital potentiometer, where the results were classified in normal buffer capacity (final pH between 5.0 and 7.0) or low (final pH <4.0). The results were evaluated regarding the normality of the sample distribution (Shapiro-Wilk test), Analysis of Variance (ANOVA) and Tukey's test. Results: Chewing gums increased the salivary flow of the volunteers, when compared to the control group (paraffin) (1.53 mL / min), differing statistically from the group, although there was no difference between Trident® (2.09 mL / Min) and Trident Total® (2.06mL / min). Regarding the buffer capacity, the values obtained were 6.94 (paraffin), 6.99 (Trident®) and 6.93 (Trident Total®), with no difference between groups (p = 0.713). Conclusion: It was concluded that chewing gums, with and without CPP-ACP, increased the salivary flow in relation to the control group. In relation to buffer capacity the values obtained for chewing gums with and without CPP-ACP, are shown to be within the normal range.

Fluoride stability in dentifrices stored in schools in a town of northern Brazil

The aim of this study was to analyze fluoride stability in dentifrices stored during nine months in schools from Careiro da Várzea, State of Amazonas, Brazil. Analysis of total fluoride concentration, total soluble fluoride, and ionic fluoride in the dentifrice samples was performed in four different time periods: at the time of purchase (baseline); after three months, after six months, and after nine months of storage. Fluoride concentration was determined using a specific electrode (Orion 96-09) connected to an ion analyzer (Orion A-720) and calibrated with fluoride standard solutions containing 2.0 to 32.0 ppm F. The results obtained during the measurements were analyzed by analysis of variance (one-way ANOVA), followed by Tukey’s test for comparison of the means. After nine months of storage, total soluble fluoride, the active form of fluoride, decreased by 21.9%. As total soluble fluoride was below the minimum required for anticaries efficacy (1,000 ppm F) in the fourth analysis, it may be concluded that anticaries potential decreased with storage time.

Dor dental nos últimos 3 meses em adolescentes e Estratégia Saúde da Família: a comparação entre duas áreas com abordagens diferentes de atenção em saúde bucal / Dental pain in the previous 3 months in adolescents and Family Health Strategy: the comparison between two areas with different to oralhealth care approaches

O estudo objetivou comparar a prevalência e a intensidade da dor dental nos últimos 3 meses em adolescentes moradores de duas áreas de abrangência da Estratégia Saúde da Família com diferentes abordagens de atenção em saúde bucal. Um estudo transversal foi realizado com 300 adolescentes de 12 a 14 anos, selecionados em escolas públicas, na cidade de Manaus, Brasil. Adolescentes de uma área com Equipe de Saúde Bucal, onde são realizadas ações de promoção de saúde (Grupo I, N=150), foram comparados com moradores de uma área onde somente é oferecido (Grupo II, N=150) tratamento odontológico. Características demográficas e socioeconômicas foram coletadas, bem como a prevalência e a intensidade de dor dental nos últimos 3 meses, empregando-se uma escala do tipo Likert. A média de idade dos participantes foi de 12,9 ± 0,8 anos, sendo 46,7 por cento meninos. A prevalência de dor dental nos últimos 3 meses foi de 33,7 por cento, e não diferiu entre os Grupos I e II (P>0,05). A intensidade de dor dental média a alta, nos últimos 3 meses, foi associada com o Grupo II (OR: 2,11 [IC95 por cento=1,17-3,81]) após ajuste para covariáveis. Adolescentes moradores da área onde somente tratamento odontológico é oferecido foram mais propensos à dor dental de maior intensa em relação àqueles moradores da área onde predominam ações de promoção de saúde.

This study sought to compare the prevalence and intensity of dental pain in the last 3 months in adolescents living in two areas within the scope of Family Health Strategy with different to oralhealth care approaches. A cross-sectional study was conducted with 300 adolescents selected from public schools in the city of Manaus, Brazil. Adolescents living in an area with an Oral Health Team in which of health promotion is predominant (Group I, N=150) were compared with those living in an area in which only dental treatment is offered (Group II, N=150). Demographic and socio-economic characteristics, oral health-related behavior and use of dental services were gathered. Prevalence and intensity of dental pain in the last 3 months was assessed using a tested and validated Likert scale. The mean age of the participants was 12.9±0.8 years, of which 46.7 percent were male. The prevalence of dental pain in the last 3 months was 33.7 percent, and did not differ between Groups I and II (P>0.05). Medium to high intensity dental pain in the last 3 months was associated with Group II (OR: 2.11 [CI95 percent=1.17-3.81]), after adjustment for covariates. Adolescents living in the area where only dental treatment is offered were more prone to severe dental pain compared to those living in the area where health programs are predominant.

Condição de saúde bucal em idosos residentes no município de Manaus, Amazonas: estimativas por sexo / Oral health conditions of elderly residents in the city of Manaus, Amazonas: estimates by sex

OBJETIVO: Caracterizar, segundo o sexo, as condições de saúde bucal em idosos residentes no município de Manaus, AM. MÉTODOS: Estudo seccional de base populacional com 667 indivíduos com idade entre 65-74 anos, aleatoriamente selecionados. As informações demográficas e socioeconômicas foram obtidas através de entrevista. O exame bucal para cárie, edentulismo, uso e necessidade de próteses foi conduzido de acordo com as normas da OMS. RESULTADOS: Participaram do estudo 206 homens e 461 mulheres, com idade média de 69,2 anos, e 71,8 por cento se declararam de cor parda. Em média, os sujeitos apresentaram 4,6 anos de estudo e renda familiar de R$ 1586,27. O índice de dentes cariados, perdidos e obturados foi de 29,0 ± 4,3, com predomínio do componente perdido (95 por cento). A média de dentes por indivíduo foi de 4,1 ± 5,7 e a prevalência de edentulismo foi de 52,2 por cento, sendo que apenas 3 por cento dos idosos apresentaram 20 dentes ou mais. O uso de prótese total superior e inferior foi observado em 79,2 por cento e 37,1 por cento, respectivamente, e a necessidade de prótese total foi de 42,6 por cento para o arco superior e 34,7 por cento para o inferior. Idosos do sexo masculino apresentaram menor índice de dentes cariados, perdidos e obturados, mais dentes e menos edentulismo em comparação com o sexo feminino. O uso de prótese total superior e inferior foi maior nas idosas, enquanto a necessidade de prótese unitária ou parcial superior e inferior foi maior nos idosos. CONCLUSÃO: As condições de saúde bucal dos idosos em Manaus caracterizaram-se pela elevada ocorrência de perda dentária, especialmente entre as mulheres. As taxas de uso e a necessidade de prótese total foram elevadas e diferentes segundo sexo.

Oral health conditions among pregnant women attended to at a health care center in Manaus, Amazonas, Brazil / Condições de saúde bucal de gestantes atendidas em uma unidade de saúde em Manaus, Amazonas, Brasil

PURPOSE: To evaluate the oral health conditions of pregnant women enrolled in the Prenatal and Birth Humanization Program of the Theomário Pinto Costa primary healthcare unit in the south-central zone of Manaus, Amazonas METHODS: The population comprised 50 pregnant women, independent of pregnancy trimester. To assess the prevalence of dental caries, we used the DMFT Index, and for gingivitis, we used the Plaque Index and Gingival Bleeding Index. A questionnaire was used to investigate socioeconomic conditions, access to dental services and self-perception regarding oral health. RESULTS: One hundred percent of the population presented with caries; the mean DMFT score was 10.0, and the M component (missing teeth) was predominant (4.28). Among the pregnant women examined, 62% presented with moderate gingival inflammation, and 64% presented with at least some plaque. With regard to educational level, 10% of the population had completed an elementary education, 20% had not completed an elementary education, 34% had completed a high school education, and 6% had not completed a university-level education. CONCLUSION: Considering the results, it can be seen that the oral health status of the population was unfavorable, although a majority considered their oral health to be normal or good.

OBJETIVO: Avaliar as condições de saúde bucal de gestantes cadastradas no Programa de Humanização no Pré-natal e Nascimento (PHPN) na Unidade Básica de Saúde "Theomário Pinto Costa, situada na zona centro-sul de Manaus-AM". METODOLOGIA: A população estudada foi composta por 50 gestantes, independente do trimestre de gravidez. Para medir a prevalência de cárie utilizou-se o índice CPO-D e para gengivite foram utilizados Índices de Placa e Sangramento Gengival. Por meio de um questionário estruturado foram investigadas as condições socioeconômicas, o acesso aos serviços odontológicos e a autopercepção em saúde bucal. RESULTADOS: A população estudada apresentou 100% de prevalência de cárie com CPO-D médio de 10,0 sendo o componente P (dentes perdidos) predominante na composição do índice (4,28). Das gestantes examinadas, 62% apresentaram inflamação gengival moderada e 64% apresentaram placa mínima. O grau de escolaridade apresentou a seguinte distribuição: 10% ensino fundamental completo; 20% ensino fundamental incompleto; 34% ensino médio completo; 6% ensino superior incompleto. CONCLUSÕES: Diante dos resultados obtidos, pôde-se constatar que as condições de saúde na população de gestantes estudadas foram desfavoráveis; entretanto, a maioria a considerou regular ou boa.

Quality of life related to oral health: contribution from social factors / Qualidade de vida relacionada à saúde bucal: contribuição dos fatores sociais

Sociodental indicators have been widely used in epidemiological research related to oral health, as they add the dimension of the impact of oral health on the quality of life of individuals and populations. Various studies have been done in order to validate new instruments to assess these subjective perceptions, however, the association between social parameters and impact on oral health-related quality of life (OHRQoL) has not been systematically studied, thus there is still doubt as to the role of the main social variables as OHRQoL impact modulators. This study aims to systematically review the literature in order to evidence the association between six social parameters and OHRQoL. Based on six exclusion criteria, the literature search revealed 40 eligible publications for analyses. The frequency of expected (positive) association between the social parameters and OHRQoL was greater than the non-expected (negative) associations for the six parameters. Conclusions: The social conditions most clearly associated with the perception of negative impact on OHRQoL were: women, with poor education and low income, immigrants or people belonging to minority ethnic groups.

Indicadores sociodentais têm sido largamente utilizados nas pesquisas epidemiológicas em saúde bucal, pois adicionam a dimensão de impacto da saúde bucal na qualidade de vida (OHRQoL) de indivíduos e populações. Inúmeros trabalhos têm sido realizados com a finalidade de validar novos instrumentos para mensurar estas percepções subjetivas; entretanto, a associação entre parâmetros sociais e OHRQoL não foi estudada de forma sistemática, havendo dúvida em relação ao papel das principais variáveis sociais como moduladores de impactos. Este estudo objetivou revisar sistematicamente a literatura para evidenciar a associação entre seis parâmetros sociais e OHRQoL. Baseados em seis critérios de exclusão, a pesquisa bibliográfica revelou quarenta artigos para análise. A frequência de associações esperadas (positivas) entre os parâmetros sociais e OHRQoL foi maior que as associações não esperadas (negativas) para os seis parâmetros. Concluiu-se que as condições sociais mais claramente associadas à percepção de impactos negativos da saúde bucal na qualidade de vida foram mulheres, de baixa escolaridade e baixa renda, imigrantes ou pessoas pertencentes a grupos étnicos minoritários.

Psychometric properties of the OHIP-14 and prevalence and severity of oral health impacts in a rural riverine population in Amazonas State, Brazil / Avaliação das propriedades psicométricas do OHIP-14 e da prevalência dos impactos da saúde bucal, em população rural ribeirinha no Amazonas, Brasil

The objectives of this study were: (1) test the psychometric properties of OHIP-14 in a rural population; and (2) compare the oral health impacts in two riverine communities in the Brazilian Amazon that were living at different distances from an urban center. Data were obtained from a cross-sectional study in a consecutive sample (n = 126). The validity was assessed through the association of OHIP with clinical and subjective variables, which showed a more significant association with: pain, caries, need of extraction or endodontic treatment; than with tooth loss, periodontal disease or need of prostheses. The stability and internal consistency were good (ICC = 0.97; Cronbach's α = 0.89). The prevalence of oral impacts was greater in the community far from the urban center [70.3 (59.9-80.7)] than in the community closer to it [44.3 (30.7-57.7)], and in women [66.7 (56.0-77.3)] in comparison with men [49.1 (35.3-62.7)]. The OHIP-14 adapted to rural populations in Amazonas State was valid, reproducible, and consistent. There was high prevalence of impacts, especially for riverine communities that lived far from urban centers.

Os objetivos do trabalho foram: (1) testar as propriedades psicométricas do OHIP-14 em população rural e (2) comparar os impactos da saúde bucal em duas comunidades ribeirinhas amazônicas, com diferentes distâncias do centro urbano. Os dados foram obtidos de uma amostra consecutiva de pacientes (n = 126) em estudo de corte transversal. A validade do instrumento foi testada pela associação do OHIP com variáveis clínicas e subjetivas, sendo mais significativa para as variáveis: dor, cárie, necessidade de extração e de endodontia que para perda dentária, doença periodontal e necessidade de prótese. Estabilidade e consistência interna foram boas (CCI = 0,97; α Cronbach = 0,89). A prevalência de impactos foi maior na comunidade mais distante do centro urbano [70,3 (59,9-80,7)] que na mais próxima [44,3 (30,7-57,7)], e nas mulheres [66,7 (56,0-77,3)] comparadas aos homens [49,1 (35,3-62,7)]. O OHIP-14 adaptado às populações rurais da Amazônia foi válido, reproduzível e consistente. A prevalência dos impactos foi alta, especialmente para ribeirinhos que vivem distante dos centros urbanos.

Evaluation of commercial fluoride solutions on bovine enamel demineralization, using pH-cycling model / Avaliação de soluções fluoretadas comerciais na redução da perda mineral em esmalte bovino, utilizando modelo de ciclagem de pH

Purpose: The aim of this in vitro study was to evaluate the fluoride concentration in mouthrinses and their capacity to intervene with the caries process. Methods: The analysis of the fluoride concentration in the solutions was carried with ion specific electrode connected to an ion analyzer. Bovine incisors enamel blocks with previously known superficial microhardness were submitted to a pH cycling model and treated with fluoridated solutions, and later reanalyzed for microhardness and fluoride incorporation. Results: The fluoride concentration (ppm) found in the solutions SANiFill- Sanikids®, Colgate Plax Fresh Mint®, Oral B®, Sorriso Fresh® and Cepacol® (not fluoridated) were, respectively: 242.91±21.89; 248.42±3.55; 248.29±11.31; 257.61±17.57 and 35.37±10.64. The lowest loss of superficial microhardness was observed with the use Sorriso Fresh® (29.66%± 8.84), followed by Plax Fresh mint® (32.99%±14.09) and Oral B® (43.00%±18.34). Conclusion: The data suggest that fluoride solutions, in proper concentrations, are capable of intervening on the phenomena of demineralization and remineralization, promoting fluoride incorporation and, consequently, decreasing the loss of microhardness on dental enamel.

Objetivo: O objetivo deste estudo in vitro foi analisar a concentração de flúor em diferentes soluções fluoretadas para bochechos e sua capacidade de interferir no processo de cárie. Metodologia: A análise da concentração de flúor nas soluções para bochecho foi realizada com eletrodo específico para íon flúor acoplado a um analisador de íons Orion. Blocos de esmalte de dentes incisivos bovinos com a microdureza superficial conhecida foram submetidos à ciclagem de pH e uso de soluções fluoretadas, sendo, posteriormente, avaliados por uma nova análise de microdureza e também pela incorporação de flúor. Resultados: As concentrações de flúor (ppm) encontradas nas soluções SANiFill®, Colgate® Plax®, Oral B®, Sorriso® e Cepacol® (não fluoretada) foram, respectivamente: 245,94; 247,61; 251,50; 258,01 e 38,44. A menor perda de porcentagem de dureza superficial foi observada com o uso da solução fluoretada Sorriso® (29,7%±14,4), seguida por Colgate® Plax® (33%±14,1) e Oral B® (43%±18,3). Todas as soluções fluoretadas analisadas mostraram capacidade de incorporar flúor no esmalte dental. Conclusão: Os dados sugerem que as soluções fluoretadas foram capazes de interferir nos fenômenos de desmineralização e remineralização, promover incorporação de flúor e, conseqüentemente, diminuir a perda de dureza no esmalte dental.

Caries experience in adolescents from a metropolitan region of the Brazilian Amazon / Experiência de cárie em adolescentes de uma região metropolitana da Amazônia brasileira

Purpose: To estimate the prevalence of dental caries among adolescents from a poor metropolitan region of the Brazilian Amazon, and to identify the independent socioeconomic variables of access to dental services, oral hygiene habits, and self-perception of oral health. Method: The sample comprised 178 adolescents aged from 15 to 19 year-old, enrolled in schools in the Eastern zone of the city of Manaus, AM, Brazil. Primary data were collected using a standardized questionnaire and clinical examination. Result: The prevalence of dental caries was 92.7%, and the mean DMF-T index was 5.16 (SD: 0.28). The average number of decayed, missing, and filled teeth was 4.4, 0.87, and 0.75, respectively. No statistically significant differences were found between DMF-T index and per capita household income. Most adolescents declared that they had had an appointment with a dentist at least once in their lifetime, had sought the public service, and that pain was the predominant reason for consultation. The perception of oral health of the majority was good/excellent. Conclusion: The data suggest lack of restorative dental treatment and high prevalence of dental caries in this socially disadvantaged sample, which evidences the need to implement strategies to improve delivery of oral health care.

Objetivo: Estimar a prevalência de cárie em adolescentes, escolares de uma região metropolitana de Manaus, Brasil, identificando variáveis independentes socioeconômicas, de acesso a serviço odontológico, hábitos de higiene oral e autopercepção da saúde bucal. Metodologia: Foram investigados 178 escolares de 15 a 19 anos, matriculados nas escolas da zona leste da cidade de Manaus, AM, Brasil. Foram coletados dados primários por meio de questionário e exame clínico. Resultado: A prevalência de cárie foi 92,7% e a média do índice CPO-D foi de 5,16 (desvio-padrão: 0,28). A média de dentes cariados, perdidos e obturados foi de 4,4; 0,87 e 0,75, respectivamente. Não foram encontradas diferenças estatisticamente significantes entre CPO-D e renda domiciliar per capita. A maioria dos adolescentes declarou já ter ido ao dentista pelo menos uma vez na vida e ter procurado o serviço público, sendo a dor o motivo predominante para a consulta. A percepção da saúde bucal da maioria foi boa/ótima. Conclusão: Os dados obtidos sugerem carência de tratamento odontológico restaurador e prevalência preocupante sobre dentes perdidos por cárie dentária, evidenciando necessidade de implantação de estratégias de atenção à saúde bucal, considerando a realidade desta população em desvantagem socioeconômica.

Prevalência de cárie dentária e condições socioeconômicas em jovens alistandos de Manaus, Amazonas, Brasil / Prevalence of dental caries and socioeconomic conditions among young conscripts in Manaus, Amazonas, Brazil

A cárie dentária tem origem multifatorial e a condição socioeconômica está inserida neste contexto. O objetivo deste estudo foi conhecer a prevalência de cárie, além de verificar sua associação com variáveis socioeconômicas em jovens alistandos de 17 a 19 anos de idade, sexo masculino, em Manaus, Amazonas, Brasil. Foi realizado um estudo transversal com uma amostra de conveniência dos conscritos das Forças Armadas Brasileiras. Os critérios de diagnóstico e questionário socioeconômico foram baseados no levantamento nacional SB Brasil e OMS. Uma única examinadora (kappa = 0,96) realizou o exame bucal em 578 alistandos. Foi utilizado o teste Shapiro-Wilk para verificação de normalidade dos dados; não sendo aceita a normalidade (p = 0,0001), foi utilizado o teste não-paramétrico Kruskall-Walis para comparação das médias e assim verificar a diferença significativa entre CPOD e seus componentes com as variáveis avaliadas. A prevalência de cárie encontrada foi de 88,8 por cento e o índice CPOD médio foi igual a 5,16 ± 0,17. Diferenças estatisticamente significantes foram encontradas nas médias dos componentes Cariado, Perdido e Obturado do índice CPOD, sendo os piores indicadores verificados nos grupos de menor escolaridade, menor renda e procedentes de escola pública, demonstrando maior necessidade de medidas preventivas e assistenciais para estes grupos.

Oferta e utilização de serviços de saúde bucal no Amazonas, Brasil: estudo de caso em população ribeirinha do Município de Coari / Provision and utilization of dental services in Amazonas State, Brazil: a case study in a riverine population in Coari Municipality

O presente estudo de caso teve o objetivo de descrever a oferta e utilização de serviços odontológicos em duas comunidades ribeirinhas do Município de Coari, Amazonas, Brasil. Para tanto, foram colhidos dados sobre freqüência de utilização de serviços de saúde bucal, por entrevistas estruturadas com indivíduos acima de 18 anos, e dados sobre oferta de serviços obtidos por entrevistas semi-estruturadas com informantes-chave. Nas análises bivariadas, embora sem diferença estatística, os indivíduos da comunidade mais distante da sede do município apresentaram maior tempo decorrido da última consulta, e menor proporção de atendimentos pelo serviço público e por barcos de saúde. A análise qualitativa das entrevistas revelou: ausência de serviço odontológico permanente nas comunidades; oferta esporádica através de barcos da saúde, com menor ocorrência dos serviços na comunidade mais distante; alto custo do deslocamento do ribeirinho à sede do município; e tratamento odontológico voltado para o controle da dor, basicamente se resumindo à extração dentária. O acesso precário dos ribeirinhos aos serviços de saúde bucal aponta para a necessidade de implantação de medidas amplas de promoção de saúde, aliada a maior oferta de serviços.

This case study described the conditions in the provision and utilization of dental services in two riverine populations in the municipality (county) of Coari, Amazonas State, Brazil. Structured questionnaires were applied to individuals 18 years and older to measure dental services utilization rates. Semi-structured interviews were also conducted with key informants to characterize the provision of such services. Although the bivariate analysis did not detect any statistically significant differences, residents of the area farthest from the county seat had gone more time since their last dental visit and received less care from public health services and riverboat clinics. The qualitative analysis showed: no permanent dental services in the communities; sporadic services provided by riverboat clinics, with less frequent visits to the remotest community; high transportation cost for river-dwellers to seek treatment in the county seat; and dental treatment focused on pain control, mainly through tooth extraction. Limited access to dental services for riverine populations highlights the need to implement comprehensive health promotion measures and expand the availability of services.