Luxation injuries in primary teeth: a retrospective study in children assisted at an emergency service.

The purpose of this study was to analyze luxation injuries in children between the ages of 0 and 5 years treated at an emergency service department. A total of 1,703 records, corresponding to a period of 10 years at the Emergency Center of the Baby Clinic at Londrina State University, Brazil, were analyzed. The age, gender, etiologic factors, type of injury, injured teeth, treatment and time interval between injury and treatment were determined for each patient. Of the examined records, 409 patients met the study criteria and included a total of 679 injured teeth. Statistical analyses were carried out using the chi-square test with the level of significance set at 5%. Trauma incidence was higher in boys (57.0%) and in children less than two years of age (40.3%). Falling while walking or running was the most predominant etiologic factor (37.7%), and the most prevalent type of injury was subluxation (32.6%). Luxation injuries decreased with increasing age (p = 0.045). Treatment usually occurred within the first 1-15 days and was significantly associated with the type of trauma (p = 0.041). "Monitor only" was the treatment most frequently observed (74.0%). In conclusion, more luxation injuries were found in younger children, predominantly in boys. Falls resulting from walking or running were the etiologic factor most observed, with subluxation as the most common type of trauma. Treatment usually occurred within the first 15 days after the injury. Despite the severity of these injuries, "monitor only" was the eligible treatment.

Luxation injuries in primary teeth: a retrospective study in children assisted at an emergency service

The purpose of this study was to analyze luxation injuries in children between the ages of 0 and 5 years treated at an emergency service department. A total of 1,703 records, corresponding to a period of 10 years at the Emergency Center of the Baby Clinic at Londrina State University, Brazil, were analyzed. The age, gender, etiologic factors, type of injury, injured teeth, treatment and time interval between injury and treatment were determined for each patient. Of the examined records, 409 patients met the study criteria and included a total of 679 injured teeth. Statistical analyses were carried out using the chi-square test with the level of significance set at 5 percent. Trauma incidence was higher in boys (57.0 percent) and in children less than two years of age (40.3 percent). Falling while walking or running was the most predominant etiologic factor (37.7 percent), and the most prevalent type of injury was subluxation (32.6 percent). Luxation injuries decreased with increasing age (p = 0.045). Treatment usually occurred within the first 1-15 days and was significantly associated with the type of trauma (p = 0.041). "Monitor only" was the treatment most frequently observed (74.0 percent). In conclusion, more luxation injuries were found in younger children, predominantly in boys. Falls resulting from walking or running were the etiologic factor most observed, with subluxation as the most common type of trauma. Treatment usually occurred within the first 15 days after the injury. Despite the severity of these injuries, "monitor only" was the eligible treatment.

Effects on permanent teeth after luxation injuries to the primary predecessors: a study in children assisted at an emergency service.

AIM: The purpose of this study is to evaluate the developmental disturbances in permanent teeth as a result of luxation injuries in the primary teeth predecessors. MATERIALS AND METHODS: A total of 5330 records, corresponding to 10 years attendance at the Emergency Center of Baby Clinic, Londrina State University, Brazil, were analyzed. Three hundred and eighty nine children were involved in this study, totaling 620 traumatized primary teeth. Clinical and radiographic examinations were carried out in the permanent successor teeth. RESULTS: In total, 623 permanent teeth were examined and developmental disturbances were detected in 126 teeth (20.2%). The white or yellow-brown discoloration of enamel was the clinical disturbance most observed (78.0%) and the crown alteration most detected through radiographic analysis was hypoplasia (86.0%). Root alterations were rare; root dilaceration was observed in only one case. The age of the children when their primary teeth received damage varied between 6 and 36 months (P = 0.000325). Intrusive luxation and avulsion were related with most of the cases of sequelae in the successor permanent teeth (P = 0.000001). CONCLUSION: The results of the present investigation emphasize the special attention required for children who suffered dental trauma at an early age, especially in cases of intrusive luxation and avulsion.

Conhecimentos, práticas e acesso a atenção à saúde bucal durante a gravidez / Knowledge, practices and access to oral heath care during pregnancy

O objetivo do presente estudo foi verificar, entre gestantes, seu conhecimento, práticas e acesso à atenção à saúde bucal, esperando com isso contribuir para a organização dos serviços de atenção à saúde durante a gravidez. Foram realizadas entrevistas estruturadas com 102 gestantes cadastradas em programa de pré-natal, em quatro Unidades Básicas de Saúde da área urbana do Município de Londrina (PR), durante o último trimestre de 2000. Mais da metade (53,9%) das gestantes entrevistadas associa a gravidez como causadora de problemas bucais e quase 10% considera arriscado realizar tratamento odontológico durante a gravidez. A maioria das entrevistadas (87,3%) declarou escovar os dentes três vezes ou mais ao dia, embora uma parcela razoável não utilize método complementar de higiene (42,2%). Quase um quarto das gestantes relatou nunca ter procurado atendimento odontológico ou tê-lo feito há mais de três anos. Vinte e cinco gestantes (24,5%) procuraram por tratamento odontológico, mas somente dez tiveram seu problema solucionado. Parcela importante das entrevistadas relatou tanto não ter recebido orientação de como cuidar de sua boca/dentes durante a gravidez (87,3%), como sobre os cuidados da higiene bucal de seu bebê (78,4%). Pela análise dos resultados obtidos, constatou-se a necessidade de um atendimento interdisciplinar às gestantes cadastradas em programa de pré-natal, visando a adoção de medidas que previnam problemas bucais e, ao mesmo tempo, promovam a saúde da gestante e de seu futuro bebê.

With the intention to contribute for the organization of health services during pregnancy, this present study verified the knowledge, practices and access to oral health care of pregnant women. Structured interviews were made with 102 pregnant women assisted by a pre-natal program from four Basic Health Units in the Municipality of Londrina, State of Paraná during the last quarter of year 2000. Over half of the subjects (53,9%) associated pregnancy as the cause of oral problems and almost 10% considered dental treatment a risk during pregnancy. Most of them (87.3%) informed that they brushed their teeth three or four times a day, although a considerable number of them (42.2%)did not use any additional hygiene method. Almost one fourth of the women reported not having looked for or undergone a dental treatment for the past three years. Twenty-five women (24.5%) underwent a dental treatment and only ten had their problems solved. An important number of subjects informed they did not receive any orientation on how to take care of their mouth and teeth during pregnancy (87.3%) and on oral hygiene care for their babies (78.4%). The data analysis evidenced the need for an interdisciplinary assistance to those pregnant women from the pre-natal program as a way to adopt preventive measures in oral problems and to promote health for them and for their babies to come.

Projeto Pró-Saúde Odontologia: relato das atividades iniciais em universidades do Estado do Paraná / Pro-saude dentistry project: report of initial activities in universities of the State of Paraná, Brazil

O Programa Nacional de Reorientação da Formação Profissional em Saúde, Pró-Saúde, tem perspectiva de que os processos de reorientação da formação ocorram simultaneamente em distintos eixos, em direção à situação desejada apontada pela Instituição de Ensino Superior, que antevê uma escola integrada ao serviço público de saúde e que dê respostas às necessidades concretas da população brasileira na formação de recursos humanos, na produção de conhecimentos e na prestação de serviços, em todos esses casos direcionados a construir o fortalecimento do Sistema Único de Saúde. Este trabalho aborda as atividades iniciais das três universidades paranaenses contempladas com o Pró-Saúde Odontologia, Universidade Estadual de Londrina, Universidade Estadual de Maringá e Pontifícia Universidade Católica do Paraná, incluindo o relatório do I Fórum Paranaense Pó-Saúde Odontologia e os encaminhamentos dele resultantes.

[Living conditions and infant mortality in the State of Paraná, Brazil, 1997/2001]. / Condições de vida e mortalidade infantil no Estado do Paraná, Brasil, 1997/2001.

This objective of this paper was to verify the relations between the living and infrastructure conditions of municipalities in the State of Paraná, Brazil, and infant mortality rate and its components. An ecological study was carried out having the 399 municipalities of the State being classified into five clusters of living conditions. Infant, neonatal and postneonatal rates were calculated for the period 1997/2001. The mean infant, neonatal and postneonatal mortality rates in the State were, respectively, 19.3, 12.0 and 7.3 per 1,000 live births. Postneonatal mortality rates ranged from 8.7 (cluster of worst living conditions) to 6.3 per 1,000 live births (in the cluster classified as having the best living conditions). Regarding the neonatal component, clusters classified as holding the best and the worst living conditions presented the lowest values: 11.8 and 11.4 per 1,000 live births, respectively. We conclude that the postneonatal component still adequately discriminate living conditions in the State of Paraná. However, there is a need of complementary studies that aim to clarify the causes of similar neonatal mortality rates observed in the richest and in the poorest cluster of municipalities.

Condicões de vida e mortalidade infantil no Estado do Paraná, Brasil, 1997/2001 / Living conditions and infant mortality in the state of Paraná, Brazil, 1997/2001

Com o objetivo de verificar se as condicões de vida e de infra-estrutura dos municípios do Estado do Paraná, Brasil, se relacionam com a taxa de mortalidade infantil e seus componentes, foi realizado estudo de agregados, com os 399 municípios do Estado agrupados em cinco clusters de condicões de vida. As taxas de mortalidade infantil, neonatal e pós-neonatal foram calculadas para o qüinqüênio 1997/2001. Observaram-se taxas médias de mortalidade infantil, neonatal e pós-neonatal no Estado de 19,3, 12,0 e 7,3 por mil nascidos vivos, respectivamente. A taxa de mortalidade infantil pós-neonatal variou de 8,7 (cluster de piores condicões) a 6,3 por mil nascidos vivos (cluster de melhores condicões de vida). Com relacão ao componente neonatal, os clusters de melhor e pior situacão apresentaram as menores taxas, com valores semelhantes: 11,8 e 11,4 por mil nascidos vivos, respectivamente. Conclui-se que o componente pós-neonatal ainda discrimina adequadamente as condicões de vida no Estado do Paraná, porém há necessidade de estudos complementares visando esclarecer as causas das taxas semelhantes de mortalidade neonatal dos clusters classificados como de melhores e de piores condicões de vida.

Condições de vida no Estado do Paraná: análise ecológica com base em variáveis do Censo Demográfico de 2000 / Living conditions in the State of Paraná: ecological analysis based on variables of the 2000 Demographic Census

As condições devida e as desigualdades sociais exercem poderosa influência nos níveis de saúde das populações. Neste sentido, este estudo, como parte de uma pesquisa que visa a analisar a relação entre condições de vida e mortalidade, apresenta uma proposta de categorização dos municípios do Paraná segundo condições de vida, com base em variáveis do Censo Demográfico de 2000, e analisa o poder discriminatório dos estratos definidos neste trabalho tendo por referência o Índice de Desenvolvimento Humano (IDH). Foram utilizadas dez variáveis do Censo Demográfico de 2000 e, após a anãlise de componentes principais e análise de Cluster pelo método K-means, construídos cinco estratos (clusters) de municípios segundo condições de vida. Comparando os estratos, por meio de análise de variância (ANOVA) e teste de Turkey post-hoc, observaram-se desigualdades relativas á infra-estrutura urbana dos municípios (abastecimento de água e coleta de lixo) e de inserção social de seus residentes (renda e escolaridade). Na comparação com o IDH-M, observou-se que os clusters seguem um padrão semelhante, com classificação dos clusters em níveis mais altos de condições de vida á medida que houve aumento do IDH-M, com diferenças estatisticamente significativas, exceto para o componente "longevidade" do IDH-M. Os resultados indicam que os estratos construídos apresentaram poder discriminatório em relação às condições de vida, tendo como base as variáveis analisadas

[Fluoride mouth-rinsing to prevent dental caries in a Brazilian municipality with fluoridated drinking water]. / Prevenção de cárie dentária por bochechos com flúor em município com água fluoretada.

OBJECTIVE: To compare the prevalence of dental caries in two groups of schoolchildren: (1) schoolchildren participating in a weekly 0.2% sodium fluoride mouth-rinsing program and (2) schoolchildren not participating in the program. METHODS: This cross-sectional study was conducted in the city (municipality) of Londrina, in the state of Paraná, Brazil; the city has fluoridated drinking water. We examined 367 12-year-old children: 190 participants in the weekly mouth-rinsing program (51.8%) and 177 nonparticipants (48.2%). The prevalence of caries was determined based on the scores for decayed, missing, and filled teeth and for decayed, missing, and filled surfaces. The examinations were performed by three examiners, with nearly perfect agreement in their diagnosis of caries (kappa = 0.90). The dependent variable was dental caries. The independent variables were: participation or nonparticipation in the mouth-rinsing program, attending a private school or a public school, frequency of tooth-brushing, amount of toothpaste used, consumption of sweets between meals, and visits to the dentist. RESULTS: The decayed, missing, and filled teeth score (mean and standard deviation) at 12 years of age was 0.85 +/- 0.059 overall, 1.0 +/- 0.058 for program participants, and 0.70 +/- 0.060 for nonparticipants. The decayed, missing, and filled surfaces score (mean and standard deviation) was 1.16 +/- 0.017, with it ranging from a low of 0.34 in one private school to a high of 1.66 in one public school. Bivariate analysis showed an association between caries (P < 0.05) and the following variables: attending a public school, participating in the mouth-rinsing program, and consuming sweets between meals more than once a day. In the multivariate analysis, attending a public school (P = 0.0004) and consuming sweets (P = 0.001) remained associated with the presence of caries. CONCLUSIONS: The weekly mouth-rinsing program was not associated with a decreased prevalence of caries, in either the public schools or the private schools. However, additional research is needed to assess the cost-effectiveness of fluoride mouthrinsing programs in populations with a higher prevalence of caries. Given the caries prevalence that we found in the schoolchildren whom we studied, the resources allocated to the fluoride mouth-rinsing program for them should probably be used to pay for other health-promotion activities with them.

Prevenção de cárie dentária por bochechos com flúor em município com água fluoretada / Fluoride mouth-rinsing to prevent dental caries in a Brazilian municipality with fluoridated drinking water

OBJETIVO: Comparar a prevalência de cárie dentária em escolares que participaram de um programa semanal de bochecho com fluoreto de sódio a 0,2 por cento com a prevalência de cárie em escolares que não participaram do programa. MÉTODOS: Estudo transversal na Cidade de Londrina, Estado do Paraná, Brasil, cuja população consome água fluoretada. Foram examinados 367 escolares de 12 anos: 190 participantes (51,8 por cento) e 177 não participantes (48,2 por cento) do programa semanal de bochecho. Os índices utilizados foram o de dentes cariados, perdidos e obturados e o de superfícies cariadas, perdidas e obturadas. Os exames foram conduzidos por três examinadores e a concordância no diagnóstico de cárie foi quase perfeita (K = 0,90). A cárie dentária foi considerada variável dependente. As variáveis independentes foram: a participação ou não no programa, estudar em escola pública ou privada, escovação dentária, quantidade de dentifrício utilizada, ingestão de doces e consulta ao dentista. RESULTADOS: O índice de dentes cariados, perdidos e obturados aos 12 anos foi 0,85 ± 0,059 (0,70 ±0,060 para não participantes e 1,0 ±0,058 para participantes). O índice de superfícies cariadas, perdidas e obturadas foi 1,16 ±0,017, variando de 0,34 a 1,66. Na análise bivariada, estiveram estatisticamente associados (P <0,05) com a presença de cárie: estudar em escola pública, participar no programa de bochecho e ingerir doces entre as refeições mais de uma vez por dia. Na análise de regressão logística multivariada, mantiveram-se associados com a presença de cárie estudar em escola pública (P = 0,0004) e ingerir doces (P = 0,0010). CONCLUSÕES: O programa de bochecho com flúor não esteve associado a menor prevalência de cárie, seja em escolas públicas ou privadas. Entretanto, outros estudos são necessários para análise de custo-efetividade do programa em populações com maior prevalência da doença. No nível de prevalência de cárie observado, o recurso destinado ao programa de bochecho com flúor poderia financiar outras ações de promoção de saúde.