Autopercepção da saúde bucal e fatores associados em pessoas idosas quilombolas: um estudo de base populacional / Self-perception of oral health and associated factors in quilombola older people: a population-based study

Resumo Objetivo investigar a autopercepção das condições bucais e fatores associados em idosos quilombolas rurais do norte de Minas Gerais, Brasil. Método Trata-se de um estudo analítico e transversal de base populacional, no qual utilizou-se uma amostragem por conglomerados com probabilidade proporcional ao tamanho (n=406). A coleta de dados envolveu a realização de entrevistas e exames clínicos odontológicos. A autopercepção das condições bucais foi avaliada por meio do GOHAI (Índice de Determinação da Saúde Bucal Geriátrica). Resultados A maioria dos idosos autopercebeu a saúde bucal como ótima (46,3%) ou regular (30,2%). Os pesquisados revelaram ainda precária saúde bucal e acesso restrito aos serviços odontológicos. Verificaram-se, na análise múltipla, associações significantes (p˂0,05) entre GOHAI regular e variáveis relativas ao local da última consulta e uso de prótese, bem como entre GOHAI ruim e variáveis atinentes ao estado conjugal, religião, motivo da última consulta, índice CPO-D e uso de prótese. Conclusão Parcela expressiva dos idosos quilombolas manifestou uma autoavaliação mais positiva da saúde bucal, divergente do quadro odontológico constatado profissionalmente. Constatou-se ainda que o relato de percepção ruim das condições bucais esteve fortemente associado a uma saúde bucal mais precária entre os investigados.

Abstract Objective to investigate self-perception of oral conditions and associated factors in rural quilombola older people in northern Minas Gerais, Brazil. Method This is an analytical and cross-sectional population-based study, in which cluster sampling with probability proportional to size (n=406) was used. Data collection involved conducting interviews and clinical dental examinations. Self-perception of oral conditions was assessed using the GOHAI (Geriatric Oral Health Determination Index). Results Most older people self-perceived oral health as excellent (46.3%) or regular (30.2%). Those surveyed also revealed precarious oral health and restricted access to dental services. In the multiple analysis, significant associations (p˂0.05) were found between regular GOHAI and variables related to the location of the last consultation and use of prosthesis, as well as between poor GOHAI and variables related to marital status, religion, reason for last consultation, CPO-D index and use of prosthesis. Conclusion A significant portion of the quilombola older people showed a more positive self-assessment of oral health, which differs from the professionally verified dental condition. It was also found that the report of poor perception of oral conditions was strongly associated with poorer oral health among those investigated.

Conhecimento, necessidade e preferência acerca da odontologia domiciliar e condições de saúde bucal de idosos domiciliados: um estudo transversal / Knowledge, needs and preferences regarding home dentistry and oral health conditions of homebound elderly people: a cross-sectional study

O trabalho visa compreender o conhecimento, preferência e necessidade de atendimento odontológico domiciliar, além de identificar a condição de saúde bucal dos idosos domiciliados e seus fatores associados. Trata-se de dois web surveys, sendo o primeiro com a população adulta escolarizada e o segundo com a população idosa. Além disso, também foi realizado um estudo com dados secundários de prontuários de idosos que utilizaram algum serviço de atendimento odontológico domiciliar para identificar a condição de saúde bucal destes. Nos três estudos foram realizadas análise descritiva, teste do qui-quadrado e regressão robusta de Poisson com um nível de significância de 5%, tendo sido usado no último estudo a análise de Cluster de dois passos, previamente à regressão, para identificar grupos de pessoas idosas em relação à condição dentária e de reabilitação. No primeiro estudo, 443 respondentes participaram, cuja predominância foi de mulheres (67,9%) e na faixa etária de 31 a 40 anos (38,8%). A maioria dos participantes (69,5%) não conhecem o que é atendimento odontológico domiciliar. No segundo estudo, 203 idosos participaram, sendo 67% mulheres, na faixa de idade de 60 a 69 anos. A maioria dessa população não conhece a odontologia domiciliar (79,8%), nunca fez uso desse tipo de serviço (95,6%) e preferem ser atendidos em consultório odontológico (68,5%). Houve associação significativa entre conhecer a Odontologia domiciliar e ter plano de saúde médico. Foi observado ainda que aqueles idosos que não têm plano de saúde e com nível de escolaridade mais baixo preferem ser atendidos em casa em relação ao consultório tradicional. No terceiro estudo, 207 prontuários de idosos foram avaliados, cujo sexo predominante foi o feminino (58,5%), com faixa de idade 80 a 89 anos e parcialmente dependentes para atividades básicas de vida diária. Em relação à condição de saúde bucal, o CPOD médio foi de 23,5, com 3,35 pares em oclusão, sendo 75,8% edêntulos funcionais. Nos prontuários, 53,6% das pessoas idosas possuíam sangramento à sondagem em algum sextante e cerca de 20% apresentavam lesão em tecido mole. Os pacientes com mais lesões foram os idosos mais jovens, diabéticos e que foram ao dentista há mais tempo. Em relação à questão periodontal, moradores de residência individual possuem mais sangramento à sondagem. Em relação à condição dentária e de reabilitação, dois clusters foram produzidos, sendo o primeiro com idosos edêntulos e pouco reabilitados e o segundo com idosos mais dentados e reabilitados. Idosos negros e que não possuem plano de saúde estiveram mais presentes no primeiro cluster. A população em geral e idosa pouco conhece e percebe que necessitam da atenção odontológica domiciliar. Como consequência, a população idosa mais independente ainda prefere ser atendida em consultório. Ademais, a condição de saúde bucal de pacientes que utilizam atendimento odontológico domiciliar ainda é precária, fruto de uma assistência odontológica mutiladora, caracterizando o cenário desigualdade social entre as pessoas idosas domiciliadas (AU).

The study is to understand the knowledge, preference and need for dental home care addition to identifying the oral health condition of the elderly living in residence and its associated factors. Two studies are web surveys, the first with the educated adult population and the second with the elderly population. The last study was a study with secondary data from medical records of elderly people who used a home dental care service to identify their oral health condition. In three was used studies, descriptive analysis, chi-square test and robust Poisson regression were performed with a significance level of 5%, and in the last study the two-step Cluster analysis , prior to the regression, to identify groups of people elderly in relation to dental and rehabilitation status. In study number one 443 respondents participated, whose predominance was women (67.9%) and aged between 31 and 40 years (38.8%). Most participants (69.5%) don't know about home dental care. At the study number two, 203 elderly people participated, 67% of whom were women, aged between 60 and 69 years. Most of the population doesn't know about home dentistry (79.8%), has never used this type of service (95.6%) and prefers to go to the dental office (68.5%). There is a significant association between knowing about home dentistry and having a medical health plan. And those elderly people who do not have health insurance and have little education prefer to be cared for at home compared to the traditional dental office. In study three, 207 medical records of the elderly were evaluated, whose predominant sex was female (58.5%), aged 80-89 years and partially dependent for basic activities of daily living. In terms of oral health status, the mean CPOD was 23.5, with 3.35 pairs in occlusion, 75.8% of whom were functional edentulous. In the medical records, 53.6% of the elderly had bleeding on probing in some sextant and about 20% had a soft tissue lesion. Patients with more injuries were the younger elderly, diabetics and those who had been to the dentist for a longer period of time. With bleeding the probing were residents of individual residences. Two clusters were produced, the first with edentulous and poorly rehabilitated elderly and the second with more dentate and rehabilitated elderly. Black elderly people who don't have health insurance were more present in the first cluster. The population and elderly don't know and realizes that they need home dental care. As a result, the more independent elderly population still prefers to be seen in the office. Furthermore, the oral health condition of patients who use home dental care is still precarious, as a result of mutilating dental care, characterizing the scenario of social inequality among elderly people living in domicile (AU).

Prevention of oral cancer through the implementation of a teledentistry platform for the elderly / Prevención del cáncer oral mediante la implementación de una plataforma de teleodontología para adultos mayores

Objective: To contribute to early diagnosis of lesions in older patients, including potentially malignant lesions or those suspected of oral cancer by support of a web-based teledentistry platform. Material and Methods:This report contains information from 27 patients with oral lesions out of a total of 135 who received mobile dental care. Specialists who participated in the study involved professionals from the disciplines of periodontics, temporomandibular disorders, oral implantology, oral radiology, oral pathology and geriatrics. Referral consultations were carried out synchronously or asynchronously. Clinical information sent to oral pathology specialists involved a medical history and a traditional description of the lesion which considered size, color, limits, symptomatology, type of surface, consistency, location, and evolution. This information was complemented with a three-dimensional representation of the lesion, simulating an extra/intra oral clinical examination including a marker tool that allows to perform the anatomical-referencing of oral lesions. Results:27 consultations from 26 patients were evaluated for oral pathology lesions. 12 lesions were diagnosed as reactive, 5 were infectious lesions, 4 of vascular etiology, 3 pigmented lesions (amalgam tattoo and smoking-related melanosis) and 3 potentially malignant lesions. The most frequent location was the tongue with 8 cases, followed by the gingiva and jugal mucosa, each with 5 cases. Four lesions required biopsy and histopathological report. Conclusion: A teledentistry platform including digital representations of oral lesions using different digital markers, also associated with a mobile system to provide dental care, constitutes an excellent tool to treat patients that present oral lesions with potential cancer risk.

Objetivo: Contribuir al diagnóstico precoz de lesiones en pacientes mayores, incluyendo lesiones potencialmente malignas o con sospecha de cáncer oral mediante el apoyo de una plataforma de teleodontología basada en la web.Material y Métodos: Este informe contiene información de 27 pacientes con lesiones orales de un total de 135 que recibieron atención odontológica móvil. Los especialistas que participaron en el estudio incluyeron profesionales de las disciplinas de periodoncia, trastornos temporomandibulares, implantología oral, radiología oral, patología oral y geriatría. Las interconsultas se realizaron de forma sincrónica o asincrónica. La información clínica enviada a los especialistas en patología oral involucró una historia clínica y una descripción tradicional de la lesión que consideró tamaño, color, límites, sintomatología, tipo de superficie, consistencia, localización y evolución. Esta información se complementó con una representación tridimensional de la lesión, simu-lando un examen clínico extra/intraoral incluyendo una herramienta marcadora que permite realizar la referenciación anatómica de las lesiones orales. Resultados: Se evaluaron 27 consultas de 26 pacientes por lesiones de patología bucal. Se diagnosticaron 12 lesiones como reactivas, 5 lesiones infecciosas, 4 de etiología vascular, 3 lesiones pigmentadas (tatuaje de amalgama y melanosis por tabaquismo) y 3 lesiones potencialmente malignas. La localización más frecuente fue lengua con 8 casos, seguida de encía y mucosa yugal con 5 casos cada una. Cuatro lesiones requirieron biopsia e informe histopatológico. Conclusión: Una plataforma de teleodontología que incluye representaciones digitales de lesiones orales utilizando diferentes marcadores digitales, también asociada a un sistema móvil para brindar atención odontológica, constituye una excelente herramienta para tratar pacientes que presentan lesiones orales con riesgo potencial de cáncer.

Salud bucal en ancianos del Hogar Provincial de Sancti Spíritus / Oral health in the elderly of the Provincial Home of Sancti Spíritus

RESUMEN Fundamento: Las personas de edad avanzada requieren atención estomatológica ajustada a su salud bucal. Objetivo: Describir la salud bucal de los ancianos pertenecientes al Hogar Provincial de Sancti Spíritus. Metodología: Se realizó un estudio observacional descriptivo transversal en el Hogar de ancianos provincial de Sancti Spíritus, entre diciembre de 2019 y agosto 2020. Se seleccionaron 72 ancianos, según criterios de inclusión. Se utilizaron métodos del nivel teórico, empírico y estadístico para estudiar las variables: Enfermedades bucales, factores de riesgo, higiene bucal, nivel de conocimientos sobre salud bucal y autopercepción de salud bucal. Resultados: En los ancianos predominó la enfermedad periodontal (29.4 %) y la disfunción masticatoria (28.6 %); los factores de riesgo que se observaron fueron la alimentación azucarada (12.8 %) y la diabetes mellitus (12.5 %), la higiene bucal deficiente (58.3 %), el nivel de conocimientos malo (51.4 %) y la autopercepción de salud bucal baja (54.2 %). Conclusiones: La salud bucal de los ancianos estudiados se caracterizó por presentar enfermedad periodontal y disfunción masticatoria en casi la tercera parte, con predominio de la alimentación azucarada y la diabetes mellitus como factores de riesgo y más de la mitad presentó higiene bucal deficiente, nivel de conocimientos malo y baja autopercepción de salud bucal.

ABSTRACT Background: Elderly people require dental care adjusted to their oral health. Objective: To describe the oral health of the elderly belonging to the Provincial Home of Sancti Spíritus. Methodology: A cross-sectional descriptive observational study was carried out in the Provincial Nursing Home of Sancti Spíritus, between December 2019 and August 2020. 72 elderly were selected, according to inclusion criteria. Theoretical, empirical and statistical level methods were used to study the variables: oral diseases, risk factors, oral hygiene, level of knowledge about oral health and self-perception of oral health. Results: In the elderly, periodontal disease (29.4 %) and masticatory dysfunction (28.6 %) predominated; the risk factors that were observed were sugary diet (12.8 %) and diabetes mellitus (12.5 %), poor oral hygiene (58.3%), poor level of knowledge (51.4 %) and low self-perception of oral health (54.2 %). Conclusion: The oral health of the elderly studied was characterized by presenting periodontal disease and masticatory dysfunction in almost a third of them, with a predominance of sugary diets and diabetes mellitus as risk factors, and more than half presented poor oral hygiene, level of poor knowledge and low self-perception of oral health.

Effect of dental education on knowledge and clinical behavior of turkish dentists' regarding oral-systemic health of geriatric patientsOral-systemic health of geriatric patients (Running title) / Efeito da educação odontológica no conhecimento e comportamento clínico de dentistas turcos em relação à saúde oral e sistêmica de pacientes geriátricos

Objective: The aim is to evaluate the perspectives of dentists' clinical approaches in terms of their knowledge and education regarding oral-systemic health relation of geriatric patients with a digital survey. Materials and Methods: The demographics, oral-systemic health-related lectures in participants' dentistry education, the level of awareness of the oral-systemic health relationship, and behaviors related to clinical applications were investigated on a digital platform with 49 multiple-choice questions. The results were analyzed with the SPSS 24.0 program. Results: Of a total of 410 dentists (206 women and 204 men), 23% have doctoral and/or specialty titles. While 93.1% of dentists had taken systemic health-related lectures, 21.3% of them rated these courses as "adequate" and 49.3% as weak. 72% of the participants received medical history only at the initial appointment, while 17.9% of them received it at each appointment. Dentists more often associate diabetes and cardiovascular diseases with periodontitis, compared to the development of dental caries. Dentists who think that they should work with physicians in the treatments of geriatric patients with systemic diseases refer more patients to physicians per year (p < 0.001). Conclusions: Dentists have found the lectures on the relationship between oral-systemic health of geriatric patients in dentistry education inadequate. Besides, there is a lack of information on the effects of systemic diseases on caries development, intra-oral findings, and knowledge on treatment approaches. Dentists believe that defining a curriculum that emphasizes interdisciplinary work and organizing scientific activities in partnership with medical associations will play an important role in establishing awareness of oral-systemic health. (AU)

Objetivo: O objetivo é avaliar as perspectivas das abordagens clínicas dos dentistas em relação ao seu conhecimento e educação sobre a relação da saúde oral e sistêmica de pacientes geriátricos através de um questionário digital. Material e Métodos: Os dados demográficos, as aulas relacionadas à saúde oral-sistêmica na educação odontológica dos participantes, o nível de conhecimento da relação saúde oral e sistêmica e os comportamentos relacionados às aplicações clínicas foram investigados em uma plataforma digital com 49 questões de múltipla escolha. Os resultados foram analisados com o programa SPSS 24.0. Resultados: De um total de 410 dentistas (206 mulheres e 204 homens), 23% possuem título de doutor e / ou especialidade. Enquanto 93,1% dos dentistas tiveram aulas sobre saúde sistêmica, 21,3% avaliaram esses cursos como "adequados" e 49,3% como fracos. 72% dos participantes recebem histórico médico apenas na consulta inicial, enquanto 17,9% deles recebem em cada consulta. Os dentistas associam mais frequentemente diabetes e doenças cardiovasculares à periodontite, em comparação ao desenvolvimento de cárie dentária. Os dentistas que acham que devem trabalhar em conjunto com médicos no tratamento de pacientes geriátricos com doenças sistêmicas encaminham mais pacientes ao médico por ano (p <0,001). Conclusões: Os cirurgiões-dentistas consideram inadequadas as palestras sobre a relação entre saúde oral e sistêmica de pacientes geriátricos no ensino de odontologia. Além disso, faltam informações sobre os efeitos das doenças sistêmicas no desenvolvimento de cárie, achados intraorais e conhecimento sobre as abordagens de tratamento. Os dentistas acreditam que a definição de um currículo que enfatize o trabalho interdisciplinar e a organização das atividades científicas em parceria com as associações médicas terá um papel importante no estabelecimento da consciência sobre a saúde oral e sistêmica (AU)

Autopercepção de saúde bucal por idosos atendidos pelo sistema público de um município de Minas Gerais / Self-perception of oral health by the elderly assisted by the public system of a municipality in Minas Gerais

Objective:To analyze the self-perception of oral health by the elderly assisted by the public system of a municipality in Minas Gerais. Methods: descriptive, cross-sectional study with a quantitative approach, carried out with 100 elderly people during dental care in a public clinic and in a reference center. The data were treated using simple descriptive statistical analysis. Results: it was observed that the changes not noticeable by the elderly were: dry mouth sensation, decreased taste, decreased salivary flow and increased gingival problems. These consider it impossible to avoid tooth loss, however they reported that care for the remaining teeth and periodic consultation with the dentist are necessary. The reasons for seeking the professional were: toothache, gum pain, need for dental treatment and mouth injury. Conclusion: the elderly showed a satisfactory perception of their oral health. You are aware of oral changes resulting from aging, as well as care

Objetivo: analisar a autopercepção de idosos atendidos em uma clínica odontológica pública e em um centro de referência de um município de Minas Gerais sobre sua saúde bucal. Métodos: trata-se de um estudo descritivo, transversal, com abordagem quantitativa, realizada com 100 idosos durante atendimento odontológico em uma clínica pública e em um centro de referência. Utilizou-se um questionário semiestruturado, adaptado e validado. O tratamento dos dados se deu por meio de análise estatística descritiva simples. Resultados: observou-se prevalência de idosos do sexo feminino, casado, branco, renda de 1-2 salários, ensino médio completo e de outros municípios. As alterações não perceptíveis pelos idosos são: sensação de boca seca, diminuição do paladar, diminuição no fluxo salivar e aumento dos problemas gengivais. Os idosos consideram ser impossível evitar a perda dentária, todavia relataram que cuidados com os dentes remanescentes e consulta periódica ao cirurgião-dentista são necessários. Os motivos da procura ao dentista foram: dor de dente, dor na gengiva, necessidade de tratamento dentário e lesão na boca. Conclusão: a maior parte dos idosos apresenta uma percepção satisfatória quanto a sua condição atual de saúde bucal. Tem ciência das alterações bucais advindas do processo de envelhecimento, bem como das medidas de cuidados

Objetivo: Analizar la autopercepción de salud bucal por ancianos asistidos por el sistema público de una ciudad de Minas Gerais. Métodos: estudio descriptivo, transversal, con enfoque cuantitativo, realizado con 100 ancianos durante la atención odontológica en una clínica pública y en un centro de referencia. Los datos fueron tratados mediante análisis estadístico descriptivo simple. Resultados: se observó que los cambios que los ancianos no notaron fueron: sensación de boca seca, disminución del sabor, disminución del flujo salival y aumento de los problemas gingivales. Estos consideran imposible evitar la pérdida de dientes, pero informaron que es necesario cuidar los dientes restantes y consultar periódicamente con el dentista. Las razones para buscar al profesional fueron: dolor de muelas, dolor de encías, necesidad de tratamiento dental y lesiones en la boca. Conclusión: los ancianos mostraron una percepción satisfactoria de su salud bucal. Tiene consciencia de los cambios orales resultantes del envejecimiento, así como de la atención

La odontogeriatría en la formación y superación de especialistas en Cuba / Geriatric Dentistry in the training and improvement of specialists in Cuba

Introducción: El envejecimiento de la población mundial en el nuevo milenio propicia que la atención al paciente geriátrico se mantenga como tema trascendental dentro de la literatura especializada contemporánea. Objetivo: Ofrecer una visión actual sobre el tratamiento de la odontogeriatría en los planes y programas de estudio en Cuba. Desarrollo: Se realizó una revisión bibliográfica en la literatura científica de los últimos 5 años a la fecha, en idioma español e inglés y se utilizaron preferentemente las bases de datos Ebsco, Pubmed y SciELO. Se consultaron artículos que abordaran la temática de la odontogeriatría en los currículos de estudio del pregrado en la carrera de estomatología y cómo se maneja la especialización desde el posgrado. Se hizo un análisis comparativo del tratamiento de esta disciplina en el ámbito mundial, de modo que se constató la necesidad de actualizar los planes y programas de estudio de la carrera de estomatología en Cuba, en aras de contribuir a una formación más integral del estudiante y de suplir esta carencia en los profesionales de la estomatología. Conclusiones: En Cuba resulta una necesidad, elevar la capacitación del estomatólogo, tanto en el pregrado como en el posgrado, en temas de odontogeriatría, con el fin de procurar una mayor calidad de vida de la población adulta mayor(AU)

Introduction: The aging of the world population in the new millennium favors that attention to the geriatric patient remains a transcendental subject within contemporary specialized literature. Objective: To offer a current vision on the treatment of the Geriatric Dentistry in Cuban plans and study programs. Development: A bibliographic review was carried out assuming the scientific literature of the last 5 years to date, in English and Spanish, using the databases Ebsco, Pubmed and Scielo. There were consulted articles that approached the Geriatric Dentistry thematic in the undergraduate study curricula of the Dentistry career and how the specialization is managed from the postgraduate level. A comparative analysis of the treatment of this Dentistry discipline was carried out worldwide, so the necessity to update the Dentistry study in Cuban plans and programs was confirmed, in order to contribute to a more comprehensive student training and fill this lack in Dentistry professionals. Conclusions: it is a necessity to increase dentists' training about Geriatric Dentistry in Cuban undergraduate and postgraduate studies in order to achieve a higher life quality in older population(AU)

Questões fonoaudiológicas e odontológicas na percepção de idosos que acessam serviços do Sistema Único de Saúde / Speech therapy and oral health issues in the perception of the older adults that access the Unified Health System

RESUMO: Modelo de estudo: Estudo observacional e transversal com dados coletados a partir de questionários aplicados aos idosos em visitas domiciliares, sobre acesso a serviços de saúde. Objetivo: Analisar a percepção de idosos independentes sobre questões fonoaudiológicas e odontológicas nos serviços de Atenção Primária à Saúde do Sistema Único de Saúde. Métodos: Foram analisadas frequências absolutas das variáveis de estudo relacionadas a questões fonoaudiológicas e odontológicas através do teste do Qui-quadrado e Teste Exato-de-Fisher, ambos com nível de 0,05% de significância. Resultados: Os idosos entrevistados foram predominantemente mulheres (76,5%), cor branca (73,5%), com no mínimo ensino médio de escolaridade (64,7%). Destes idosos, 92,6% afirmaram não possuir dificuldades para se alimentar, apesar de 51,5% nunca ter feito uma avaliação fonoaudiológica. Houve maior proporção indicando que os idosos não necessitaram de consulta com fonoaudióloga (73,5%). Quanto à utilização de serviços da atenção primária, 68,7% utilizavam o sistema público e desses, 94,1% autoperceberam sua condição de saúde bucal como regular/ruim. Conclusão: Sugere-se o fortalecimento do cuidado dos idosos de forma interdisciplinar e integral, a fim de abranger as necessidades e especificidades dessa população. A baixa percepção da importância do cuidado sugere a necessidade do fortalecimento dos serviços de fonoaudiologia para a saúde da população idosa brasileira. (AU)

ABSTRACT: Study design: Cross-sectional study with data collected from questionnaires applied to older adults at domiciliary visits regarding access to health services. Objective: Analyzing the perception of independent elderly about speech-language and dental issues in the Primary Health Care Services of the Unified Health System/SUS. Methods: Absolute frequencies of the study variables related to speech-language and dental questions were analyzed using the Chi-square test and Fisher's Exact Test, both with a 0.05% significance level. Results: The elderly interviewed were predominantly women (76.5%), white (73.5%), with at least high school education (64.7%). Of these, 92.6% said they had no difficulty in eating, although 51.5% never had a speech therapist evaluation. There was also a higher proportion indicating that the elderly did not need an appointment with the speech therapist (73.5%). Regarding the use of primary care services, 68.7% used the public system, and of these, 94.1% self-perceived their oral health condition as fair/poor. Conclusion: It is suggested to strengthen the care of the elderly in an interdisciplinary and integral way to cover the needs and specificities of this population. The low perception of the importance of care suggests the need for strengthening speech therapy services for the health of the elderly Brazilian population. (AU)

COVID-19 and Geriatric Dentistry: What will be the new-normal? / COVID-19 e Odontologia Geriátrica: Qual será o novo normal?

Older adults may face many barriers when accessing oral health care. The most vulnerable groups are people living in long term care institutions and the homebound. These barriers are related but not limited to socio-economic issues, medical and oral health problems. Some socio-economic problems are lack of finances, absence of dental insurance, lack of social support networks, and being institutionalized. Some general health problems are multiple co-morbidities, polypharmacy, dementia, and reduced autonomy. Some oral health problems are having heavily restored dentitions, dry mouth, root caries, and inability to maintain adequate oral hygiene independently. In addition to these existing barriers, many new barriers have arisen which are expected to further reduce access to oral health care for older adults due to the emergence of the COVID-19 pandemic. Older adults are at greater risk of fatal outcomes from COVID-19 infection and many dental procedures have an increased risk of creating aerosols, thereby spreading COVID-19 infection. Consequently, older adults due to fear are less likely to seek or receive oral health care until a treatment or vaccine is developed for COVID-19 infections. In this article, the authors discuss the implications of the COVID-19 pandemic to the practice of geriatric dentistry, and what is expected to be the "new normal" in this field of dentistry (AU)

Os idosos geralmente enfrentam muitas barreiras para acessar os serviços de saúde bucal. Os grupos mais vulneráveis são formados por pessoas que vivem em instituições de longa permanência ou estão restritos às suas casas. Essas barreiras estão relacionadas, entre outras, a questões socioeconômicas e problemas de saúde geral e oral. Alguns problemas socioeconômicos são: problemas financeiros, falta de convênio odontológico, falta de redes de apoio social e institucionalização. Alguns problemas gerais de saúde são: múltiplas comorbidades, polifarmácia, demência e autonomia reduzida. Alguns problemas de saúde bucal são: dentição muito restaurada, boca seca, cárie radicular e incapacidade de manter uma higiene bucal adequada de forma independente. Além das barreiras já existentes, devido ao surgimento da pandemia de COVID-19 surgiram novas barreiras que deverão reduzir ainda mais o acesso aos cuidados de saúde bucal para idosos. Idosos correm maior risco de complicações fatais da COVID-19 e muitos procedimentos odontológicos têm um risco aumentado de gerar aerossóis, espalhando assim a COVID-19. Consequentemente, os idosos têm menor probabilidade de procurar ou receber cuidados de saúde bucal devido ao medo, até que um tratamento ou vacina seja desenvolvido para a COVID-19. Neste artigo, os autores discutem as implicações da pandemia de COVID-19 na prática da odontologia geriátrica e o que se espera ser o "novo normal" nesse campo da Odontologia.(AU)

Características de Autocuidado em Saúde Oral, Hábitos e Acesso a Serviço Odontológico por Idosos Rurais e Urbanos / Characteristics of oral health self-care, habits and access to dental service by rural and urban elderly / Características del autocuidado en salud bucal, hábitos y acceso al servicio odontológico por ancianos rurales y urbanos

O artigo buscou investigar as diferenças no estado de saúde oral entre idosos rurais e urbanos, incluindo características de autocuidado, hábitos e acesso a serviços odontológicos, através daPesquisa Nacional de Saúde de2013.Foram encontrados perfis diferentes depacientes,de acordo com a zonageográfica.Idosos urbanosmostraram melhores indicadores de saúde oral, agendamento com maior uso de tecnologiase menor busca de tratamentospor patologia oral que os idosos rurais.

We have investigated the differences related to oral health status between urban and rural elderly, including oral health self-care, habits and access to dental service characteristics. Data was obtained from Brazilian National Health Survey (2013). According to geographic area we have found different profiles. Urbans demonstrated better indicators of oral health status, more use of technology to appoint a dentistry consultation and less looking for treatment because oral pathology than rural elderly.

El artículo buscó investigar las diferencias en el estado de salud bucal entre ancianos rurales y urbanos, incluyendo características de autocuidado, hábitos y acceso a servicios dentales, a través de la Encuesta Nacional de Salud de 2013. Se encontraron diferentes perfiles de pacientes, segúnel área geográfica.Los ancianos urbanos mostraron mejores indicadores de salud bucal, programación con mayor uso de tecnologías y menor búsqueda de tratamientos para patología oral que los ancianos rurales.

Gerontología en la formación de pre grado del odontólogo del siglo XXI / Gerontology in the pre doctoral academic training at the 21th century

RESUMEN: La gerontología es la ciencia que trata de la vejez y los fenómenos que la caracterizan. Se aboca al estudio científico del proceso de envejecimiento y abarca la esfera social, psicológica y biológica. El fenómeno actual del envejecimiento de la población mundial, denominado "transición demográfica", ha puesto al quehacer de la gerontología en acuciante actualidad. Dentro de su marco conceptual, en el ámbito de la ciencia médica, surge la geriatría, especialidad que se ocupa no sólo de la prevención y asistencia de las enfermedades que presentan las personas mayores, sino también de su recuperación funcional y de su reinserción en la comunidad. En Chile, sin constituirse en una especialidad propiamente tal, la llamada "odontogeriatría" vendría a ser el equivalente de geriatría en odontología. Sin embargo, creemos que gerodontología sería más pertinente puesto que apreciamos en ésta, una visión cultural derivada de la gerontología que va allende los aspectos procedimentales propios de la odontología. Pretendemos fundamentar esta afirmación, analizando la experiencia internacional, contrastándola con la situación que se verifica en Chile, reiterando la imperiosa necesidad de comenzar desde la formación de pre grado del futuro odontólogo con la entrega de insumos gerodontológicos teóricos y clínicos, para intentar aportar de modo propositivo y no efectista, en el diseño de políticas públicas actualizadas.

SUMMARY: Gerontology is the science studying ageing and the phenomena that characterize it. It deals with the scientific approach of this process encompassing the social, psychological and biological fields. The current phenomenon of the ageing of the world population, so called "demographic transition" has put the gerontological issue in pressing today. Within its conceptual frame and in the sphere of medical sciences emerges Geriatrics, specialty covering not only prevention and care of older people diseases, but also addressing its functional recovery and reintegration into the community. In Chile, not yet a specialty, geriatric dentistry would be its equivalent regarding odontology. However, we believe that there is a conceptual difference regarding gerodontology since we appreciate its scope goes far beyond the procedural aspects of dentistry. We will make our statement, analyzing evidence from international educational experiences, as well as contrasting with the situation that occurs in Chile, altogether stressing the urgent need to start from the undergraduate curriculum of future dentists through the delivery of theoretical input and clinical gerodontologic training, in order to collaborate in a proactive way in the design of updated public policies according to the nowadays challenges.

Prevalence of oral mucosal lesions in geriatric patients in Universitas Airlangga Dental Hospital

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Population aged 60 years old and above are growing in number; a fact that will have an impact on general and oral health in the future. Oral health is often overlooked in the management of geriatric patients but it is vital to have a knowledged-based practice in order to increase the quality of life of elderly patients.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> The purpose of this study is to determine the number and types of oral mucosal lesions in geriatric patients who come to the Universitas Airlangga Dental Hospital.</p><p style="text-align: justify;"><strong>METHODS:</strong> This is an observational descriptive study with cross-sectional design. Intraoral soft tissue examination was performed on geriatric patients coming to the hospital between March and December 2018.</p><p style="text-align: justify;"><strong>RESULTS:</strong> One hundred twenty-four (124) new geriatric patients came to the hospital. A total of 152 oral lesions from 63 geriatric patients (50.81%) were identified.  Overall, coated tongue (55.56%) was the most frequently detected lesion, followed by linea alba buccalis (31.74%) and lingual varicosities (26.98%).</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Coated tongue or white tongue is the most frequently detected oral mucosal lesion, often caused by poor oral hygiene. The dentist should be able to recognize and differentiate them from the worrisome lesions and decide on the appropriate treatment in geriatric patients.</p>

Protocol for the evaluation of chewing among older adults / Protocolo de avaliação da mastigação do idoso

Abstract Objectives : To evaluate the functional and physiological structures of the stomatognathic system of the oral cavity of older adults based on self-perception, comparing the same with a professional clinical evaluation, and investigating the difficulties encountered when chewing. Method : An analytical cross-sectional study with a quantitative approach was conducted with a sample of 53 older adults aged 60 to 90 years. A protocol consisting of three questionnaires was used: a sociodemographic evaluation, a self-perception based interview with 19 questions on the chewing of the older adults and a clinical evaluation containing 30 questions covering aspects of the oral cavity tissue. The self-perception and clinical evaluation scores were compared using the Mann-Whitney test and the proportions observed for each item were compared by the binomial test. Results : It was found that the self-perception of older adults did not correspond to the result of the clinical evaluation. While 31 (58.5%) reported satisfaction with chewing, 16 (30.2%) had high/very high impairment and 14(26.4%) moderate impairment, based on the results of the clinical evaluation found. Conclusion : It was found that the chewing analysis process cannot be exclusively based on the answers provided by the older adults, and assessment proved to be more accurate when combined with a clinical evaluation performed by a professional.

Resumo Objetivos : Avaliar as estruturas funcionais e fisiológicas do sistema estomatognático da cavidade bucal dos idosos diante da autopercepção, comparando-as com a avaliação clínica profissional e investigar as dificuldades encontradas para realizar sua mastigação. Método : Estudo transversal analítico de abordagem quantitativa, realizado com uma amostra de 53 idosos, idade entre 60 e 90 anos. Foi utilizado um protocolo constituído de três questionários: uma avaliação sociodemográfica, uma entrevista de autopercepção com 19 quesitos da mastigação do idoso e uma avaliação clínica contendo 30 quesitos abrangendo os aspectos teciduais da cavidade bucal. Os escores da autopercepção e da avaliação clínica foram comparados pelo teste de Mann-Whitney e as proporções observadas para cada item pelo teste binomial. Resultados : Constatou-se que a autopercepção relatada pelos idosos não correspondeu ao resultado da avaliação clínica. Enquanto 31 (58,5%) relataram satisfação com a mastigação, 16 (30,2%) possuíam comprometimento alto/muito alto e 14 (26,4%) comprometimento moderado. Conclusão : Evidenciou-se que o processo de análise da mastigação não pode ser realizado exclusivamente pelas respostas prestadas pelo idoso, sendo mais adequado quando se adiciona a etapa da avaliação clínica feita por um profissional.

Saúde bucal de idosos com 80 anos ou mais: condição, autopercepção e utilização de serviços odontológicos / Oral health of the elderly with 80 years or more: condition, self-perception and use of dental services

Introdução: Idosos mais velhos têm saúde bucal precária, procuram pouco os serviços odontológicos e apresentam autopercepção sobre saúde bucal discordante das necessidades de tratamento. Objetivo: Comparar a condição e autopercepção de saúde bucal e padrão de utilização de serviços odontológicos de idosos com 80 anos ou mais de um município do sul brasileiro. Método: Estudo descritivo com 59 idosos, em 2011 e 2015, no município de Antônio Carlos, Santa Catarina. Foram coletados dados demográficos, uso dos serviços, Oral Health Impact Profile - 14 item, hábitos e algumas condições bucais. Resultado: Em ambos os anos, constatou-se mais de 70% de idosos necessitando de prótese total superior, embora mais de 80% se apresentassem satisfeitos com dentes/próteses. Mais de 60% relataram que haviam consultado o dentista há mais de 3 anos. Houve aumento significativo da necessidade de prótese total inferior, boca seca, placa, desconforto para comer; diminuição de consulta odontológica de rotina e extração dentária. Conclusão: Embora tenha havido diminuição das extrações, no período, os idosos mantiveram necessidade de prótese e relataram problemas para comer. Tais resultados reafirmam a importância da inclusão do idoso com 80 anos ou mais na rede de serviços de saúde bucal.

Introduction: Older elderly people have poor oral health, not usually seek for dental services, and self-perceived oral health that is inconsistent with treatment needs. Objective: To compare the oral health condition, self-perception and use of dental services of elderly people with 80+ years of age in a southern Brazilian municipality. Method: Descriptive study with 59 elders, in 2011 and 2015, Antônio Carlos, Santa Catarina. Demographic data, use of services, Oral Health Impact Profile - 14 item, habits and some oral conditions were investigated. Result: In both years, more than 70% required upper dentures, although more than 80% were satisfied with teeth/prosthesis. More than 60% reported last dental visit more than 3 years ago. It was observed a significative increasing in lower denture need, dry mouth, plaque and discomfort to eat; decreasing routine dental visits and tooth extraction. Conclusion: Although there was a decrease in extractions, the elderly had prosthetic need and reported problems with eating. These results reaffirm the importance of including the elderly with 80+ years in the oral health services network.

How clinically important is the p-value? / Clinicamente que tan importante es el Valor-p?

Currently, it has been observed a growing number of publications in all fields of Dentistry. These publications act as scientific evidence, as well as a basis for clinical decision-making in dental care routine. It is important to note that the results and conclusions in articles are based on the p-value that is a purely probabilistic and statistical parameter, and it assists the researcher to accept or reject the null hypothesis being tested. The p-value was proposed by Fisher in 1925, and in Dentistry, it is usual to adopt the p-value stated in 0.05.1 In practical terms, when a statistical test results in p-value less than 0.05, the null hypothesis must be rejected (equality between groups), assuming that there is a difference between the assessed groups.2 In other words, p<0.05 indicates statistically significant difference between groups. Under a critical look, the researcher and reader should keep in mind that a statistical difference is not always reflecting a true clinical importance. In addition, a lack of statistical significance does not necessarily relate to the absence of clinical significance. The clinical importance is far beyond statistical calculations based on the p-value.3 A study presents clinical importance when the one being tested presents clinical effect capable to change the behavior of the dentist in daily routine. This judgment should be done by the researcher based on the results of his/her research, clinical experience and actual knowledge. In addition, estimates of effect sizes should be presented. This facilitates assessment of how large or small the observed effect could actually be in the population of interest, and hence how clinically important it could be. Kassab et al. (2006)4 compared periodontal parameters in groups with and without chemical biomodifciation of the root prior surgical coverage in cases of gingival recession. The group, that used edetic acid, statistically improved the periodontal parameters in relation to the group without surface biomodification. However, this difference was imperceptible to both dentist and patient. That is, the clinical result of root coverage will be the same when using or not acid biomodification of the root. In other words, there was not an important clinical effect of this step, although there was a significant difference. In the above example, it is clear that just because a statistic test is significant doesn't mean the effect it measures is significant or clinically important. Then, researchers

Multidisciplinaridade no cuidado e atenção à saúde bucal do idoso / Multidisciplinarity in the care and attention for the oral health of elderly individuals

Este artigo tem como objetivo revisar a literatura acerca da importância da equipe multidisciplinar no cuidado e atenção à saúde bucal do idoso. Foram realizadas buscas bibliográfi cas nas seguintes bases de dados: Bireme, SciELO, LILACS, PubMed e MedLine utilizando os seguintes descritores: "Odontologia geriátrica", "Assistência integral à saúde do idoso" e "Reabilitação bucal", assim como os respectivos termos em inglês: "Geriatric dentistry", "Comprehensive health care" e "Mouth reabilitation". Foram incluídos artigos científicos em inglês e português, bem como documentos de entidades públicas nacionais e internacionais, publicados entre 2000 e 2016. Foram excluídas as teses, dissertações e estudos que não abordavam a temática principal da presente pesquisa. Como resultado, a partir da revisão de literatura realizada, verificou-se que os idosos fazem parte de um grupo populacional que apresenta, frequentemente, alterações fisiológicas e patológicas diversas, tanto relacionadas à saúde geral como à saúde bucal, podendo estar associadas ao uso crônico de medicamentos, aos hábitos de alimentação e higiene e à própria motivação do paciente. Portanto, conclui-se ser necessária uma abordagem multidisciplinar em todas as fases de atendimento do idoso, desde o diagnóstico precoce, assim como durante o planejamento e tratamento integrado, para contribuir na melhoria de sua qualidade de vida.

To review the literature about the importance of multidisciplinary teams in the care and attention for the oral health of elderly people. The following databases were searched: Bireme, SciELO, LILACS, PubMed and MedLine, using specific keywords: "Geriatric dentistry", "Comprehensive health care" and "Mouth rehabilitation". Scientific articles both in English and Portuguese were included, and documents of national and international public entities, published between 2000 and 2016. Theses, dissertations and studies that did not address the main topic of this research were excluded. From the literature review, it was verified that the elderly represent a population group that often presents a high level of physiological and pathological alterations, both related to general health and oral health, and may be associated to the chronic use of medications, dietary and hygiene habits, and the patient's own motivation. A multidisciplinary approach is required in all stages of care for elderly patients, from early diagnosis to an integrated planning and treatment, contributing to the improvement of their quality of life.

Rehabilitación protésica de adultos mayores con dispepsia funcional / Prosthetics rehabilitation in elderly with functional dyspepsia

Se realizó un estudio descriptivo y transversal de 71 adultos mayores con dispepsia funcional, atendidos en el Servicio de Gastroenterología del Policlínico Sur Asdrúbal López Vázquez de la provincia de Guantánamo, desde mayo de 2012 hasta igual mes de 2014, con el objetivo de evaluar la efectividad de la rehabilitación protésica en estos pacientes. En la serie predominaron el sexo femenino (53,7 por ciento), el grupo etario de 60-69 años (53,7 por ciento), la sensación de plenitud y la saciedad precoz como síntomas principales, así como los dientes perdidos, según el índice de mortalidad dentaria (30,4 por ciento). El tratamiento rehabilitador permitió eliminar casi el total de los síntomas encontrados, por lo cual resultó efectivo y constituye un elemento a tener en cuenta para eliminar o disminuir los síntomas en ancianos con este trastorno

A descriptive and cross-sectional study of 71 elderly with functional dyspepsia, assisted in the Gastroenterology Service of Asdrúbal López Vázquez Southern Polyclinic in Guantánamo, was carried out from May, 2012 to the same month in 2014, with the objective of evaluating the effectiveness of the prosthetics rehabilitation in these patients. In the series there was a prevalence of the female sex (53.7 percent), 60-69 age group (53.7 percent) and early sensation of filling as main symptoms, as well as the lost teeth, according to the dental mortality rate (30.4 percent). The rehabilitative treatment allowed to eliminate almost all the symptoms found, reason why it was effective and constitutes an element to take into account to eliminate or diminish the symptoms in elderly with this disorder

Enfermedades bucales y factores de riesgo en la población geriátrica perteneciente a un consultorio médico / Oral diseases and risk factors in the geriatric population of a family doctor's office

Se realizó un estudio descriptivo y transversal, desde noviembre de 2016 hasta abril de 2017, de los 166 adultos mayores pertenecientes al consultorio médico No 20 del Policlínico Carlos Juan Finlay del municipio de Santiago de Cuba, para evaluar la presencia de enfermedades bucodentales y los factores de riesgo. Para la recolección de la información se utilizó la encuesta de salud bucal de la Organización Mundial de la Salud y la historia de salud bucal familiar. Los hábitos nocivos como la deficiente higiene bucal y la dieta cariogénica, además de las enfermedades crónicas no transmisibles, fueron los factores de riesgo más comunes en esta población, en quienes la disfunción masticatoria y la caries dental constituyeron los problemas principales

A descriptive and cross-sectional study of 166 elderly belonging to the family doctor office No 20 of Carlos J Finlay Polyclinic in the municipality of Santiago de Cuba, was carried out from November, 2016 to April, 2017, to evaluate the presence of oral-dental diseases and risk factors. The survey of oral health from the World Health Organization and the medical record of family oral health were used for gathering the information. Harmful habits as poor oral hygiene and a cariogenic diet, besides non communicable chronic diseases, were the most common risk factors in this population, for whom masticatory dysfuntion and dental decay constituted the main problems

Dentists' perceptions and barriers to provide oral care for dependent elderly at home, long-term care institutions or hospitals

Aim: The aim of this study was to assess the perceptions and barriers to providing oral health care for the dependent elderly in unconventional settings as reported by dentists in the State of São Paulo, Brazil. The Brazilian elderly population is rapidly growing, and a larger elderly population implies an increasing number of dependent elderly patients. Therefore, investigating the perceptions and barriers reported by dentists for caring for these patients becomes important. Materials and methods: An online survey was sent by e-mail to dentists of a metropolitan area in the State of São Paulo, Brazil. Results: The response rate was 3.65% (n = 125). Only 14.4% of respondents offered home care to the elderly. Lack of experience or training (60.7%) and the small number of home visits (42.9%), were the main reported barriers to providing care for the dependent elderly. Most of the respondents (82.4%) agreed that the age of the patient did not influence their decision to provide care, and 96.8% agreed that delivering care to the elderly could be a rewarding experience. Conclusion: Few respondents offered care to the elderly and some of the most relevant factors considered in the decision to offer care were, experience and training, personal satisfaction and having gerodontology as a stand-alone course during dental school