Effectiveness of local hemostatic to prevent bleeding in dental patients on anticoagulation: A systematic review and network meta-analysis.

This study aimed to determine the effectiveness of hemostatic protocols to prevent bleeding in dental procedures among individuals undergoing oral anticoagulation therapy. A systematic review and network meta-analysis were accomplished. Searches of literature and grey literature were performed in different electronic databases. Clinical trials were considered as part of the inclusion criteria. Data extraction and assessment of the risk of bias of the included articles were performed. Assessment of the certainty of evidence was also performed. As results we find that the N-butyl-2-cyanoacrylate [RR -35.00 (95% CI - 107.12, -5.78)], calcium sulfate (CaSO4) [RR -5.62 (95% CI -11.41, -1.03)], and tranexamic acid (TXA) [RR -3.46 (95% CI -7.63, -0.77)] showed beneficial effects compared to placebo. However, only TXA presented beneficial effects with moderate certainty evidence. N-butyl-2-cyanoacrylate and CaSO4 presented very low certainty evidence. In the comparisons between the hemostatic agents, no differences were observed. For the mean bleeding time, no significant difference in the comparisons was observed as well. Concluding, bleeding events in individuals on oral anticoagulation decreased with the use of TXA compared to placebo. N-butyl-2-cyanoacrylate and CaSO4 were also superior to placebo, but the certainty of evidence was low. For the mean bleeding time, no significant difference in hemostatic agents was observed.

A national study on the use of opioid analgesics in dentistry.

The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.

A national study on the use of opioid analgesics in dentistry

Abstract The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.

The economic burden of opioid prescription by dentists: A 12-month survey of consumer expenditure in Brazil.

OBJECTIVES: To describe consumer expenditure on opioids prescribed by dentists in Brazil during a 12-month period. METHODS: We surveyed individual dispensed prescriptions of opioids in private pharmacies from October 2012 to September 2013. A descriptive analysis of costs included a calculation of the overall and mean maximum price to consumers. Monetary costs were converted from local currency units (Brazilian Real - BRL) to international dollars using purchasing power parity (PPP) exchanging rates. RESULTS: 129,708 prescriptions were retrieved from the database. The overall expenditure on opioids was R$4,316,383.46 BRL or $2,721,315.82 (PPP). The mean cost of an individual prescription was R$33.27 BRL ($20.98 PPP), ranging from 14.19 to 3,255.60 BRL. Codeine was frequently prescribed (87.2 percent). CONCLUSIONS: The expenditure on opioids is a significant cost to Brazilian patients, especially given that the Brazilian Public Health System should dispense these drugs free of charge. Codeine was the most prescribed opioid.

Anxiolytics, Sedatives, and Hypnotics Prescribed by Dentists in Brazil in 2010.

OBJECTIVE: To describe dental prescriptions for anxiolytics, sedatives, and hypnotics for Brazilian outpatients in 2010. METHODS: A cross-sectional study was conducted using data on the use of anxiolytics, sedatives, and hypnotics from the Brazilian Health Surveillance Agency, Brazil, 2010. For each prescription, prescribed drugs and the prescribed amount were identified. Prescribed medications were classified according to Anatomical Therapeutic Chemical code. We calculated the number of Defined Daily Doses (DDD) for anxiolytics, sedatives, and hypnotics by code, their mean DDD, and DDD per inhabitant per year. RESULTS: There were 16,436 prescriptions dispensed, including anxiolytics, sedatives, and hypnotics. These prescriptions corresponded to 3,555,780.50 mg, distributed as 2,286,200.50 mg (64.30%) of anxiolytics and 1,269,580.00 mg (35.70%) of sedatives and hypnotics. This amount allowed treating approximately 474,106 individuals (number of DDD). The anxiolytics most frequently dispensed were bromazepam (25.30%), alprazolam (19.19%), and diazepam (15.60%). Sedatives and hypnotics mostly prescribed were zolpidem (9.55%), midazolam (6.99%), and flunitrazepam (2.14%). The per capita rates (100,000 inhabitants) of anxiolytics and sedatives/hypnotics were 6.83 and 1.78, respectively. CONCLUSIONS: Benzodiazepines and derivatives were the most frequently prescribed drugs. There was a low rate of dental prescriptions for anxiolytics, sedatives, and hypnotics, although excessive doses were concentrated in the same prescription.

Exodontias no Sistema Único de Saúde em Minas Gerais: uma série temporal de 15 anos / Tooth extraction in the Brazilian Health System, Minas Gerais state: a 15-year time-series

Objetivo: Avaliar a tendência histórica de extrações dentárias no Estado de Minas Gerais entre os anos de 1998 e 2012. Métodos: Trata-se de um estudo de série temporal de exodontias de dentes permanentes no Estado de Minas Gerais, tendo sido os dados coletados no Sistema de Informações Ambulatoriais do Sistema Único de Saúde em 2013. Duas taxas de exodontias foram calculadas, ano a ano. A primeira refere-se à razão entre número total de exodontias de dentes permanentes dividida por todos os procedimentos preventivos, restauradores e cirúrgicos da atenção primária. A segunda foi a razão entre o número total de exodontias de dentes permanentes pelo número de habitantes. A análise estatística envolveu a construção de curvas de tendência histórica. Resultados: As duas taxas de exodontias comportaram-se de maneira errática no período avaliado. Houve uma ligeira tendência de aumento na taxa de exodontias por procedimentos da atenção primária e ligeira tendência de redução na taxa de exodontias pela população do Estado de Minas Gerais. Conclusão: As ligeiras tendências de aumento ou redução das taxas de exodontias revelam que as mesmas permaneceram constantes no período avaliado no Estado de Minas Gerais.(AU)

Aim: To evaluate the time-series of permanent tooth extraction in the state of Minas Gerais between the years 1998 and 2012. Methods: This is a timeseries study of permanent tooth extraction in the state of Minas Gerais. Data were collected in the Brazilian National Health Information System in 2013. Two annual rates of tooth extraction were calculated. The first was the ratio of the extractions of permanent teeth in relation to the total number of individual dental procedures in primary care. The second was the ratio of the number of extractions of permanent teeth divided by the total population. The statistical analysis of the time series was performed. Results: The two extractions rates behaved erratically during the study period. There was a slight tendency to increase in tooth extraction rate via primary care procedures and slight downward trend in tooth extraction rate in Minas Gerais state population. Conclusions: The slightly tendency in increase or decrease of the tooth extraction rates reveal that they remained constant in this period in the state of Minas Gerais.(AU)

A 15-Year Time-series Study of Tooth Extraction in Brazil.

Tooth loss is considered to be a public health problem. Time-series studies that assess the influence of social conditions and access to health services on tooth loss are scarce.This study aimed to examine the time-series of permanent tooth extraction in Brazil between 1998 and 2012 and to compare these series in municipalities with different Human Development Index (HDI) scores and with different access to distinct primary and secondary care.The time-series study was performed between 1998 and 2012, using data from the Brazilian National Health Information System. Time-series study was performed between 1998 and 2012. Two annual rates of tooth extraction were calculated and evaluated separately according to 3 parameters: the HDI, the presence of a Dental Specialty Center, and coverage by Oral Health Teams. The time-series was analyzed using a linear regression model.An overall decrease in the tooth-loss tendencies during this period was observed, particularly in the tooth-extraction rate during primary care procedures. In the municipalities with an HDI that was lower than the median, the average tooth-loss rates were higher than in the municipalities with a higher HDI. The municipalities with lower rates of Oral Health Team coverage also showed lower extraction rates than the municipalities with higher coverage rates.In general, Brazil has shown a decrease in the trend to extract permanent teeth during these 15 years. Increased human development and access to dental services have influenced tooth-extraction rates.

[Analysis of secondary care in oral health in the state of Minas Gerais, Brazil]. / Análise da atenção secundária em saúde bucal no estado de Minas Gerais, Brasil.

The scope of this study was to describe and analyze specialized outpatient procedures in periodontics, endodontics and oral surgery performed in the State of Minas Gerais in 2010. Secondary data for the procedures performed in healthcare facilities and registered in the Information System of the Unified Health System were used. Descriptive and bivariate analysis was performed, considering p <0.05. 707,559 procedures were performed in 2,547 health units distributed in 693 (81%) counties in the State. Of these procedures, 55% are in the area of surgery, 28% in periodontics and 17% in endodontics. The units are predominantly public under municipal administration, 52.5% of which have an oral health team (OHT) and 96.9% have no qualification as Dental Specialty Centers (DSCs). DSCs are more efficient than the other units (p <0.001), but there is a significant percentage that fails to comply with the goals of the Ministry of Health. Municipalities that have DSCs have higher population, more OHTs, lower potential coverage and better HDI. A significant number of specialized procedures are performed in the State of Minas Gerais, especially in primary care settings. DSC establishments are more efficient than non-DSC, considering the average number of procedures. The minimum production goals are met by a minority of DSCs.

Análise da atenção secundária em saúde bucal no estado de Minas Gerais, Brasil / Analysis of secondary care in oral health in the state of Minas Gerais, Brazil

Este estudo descreveu e analisou os procedimentos especializados ambulatoriais nas áreas de periodontia, endodontia e cirurgia bucal em Minas Gerais, 2010. Utilizou-se dados secundários dos procedimentos realizados nos estabelecimentos de saúde e registrados no Sistema de Informação do Sistema Único de Saúde. A análise descritiva e bivariada foi realizada, considerando p < 0,05. Foram executados 707.559 procedimentos em 2.547 unidades de saúde distribuídas em 693 (81%) municípios. Destes procedimentos, 55% são da área de cirurgia, 28% da periodontia e 17% são da endodontia. As unidades são predominante públicas, sob administração municipal, 52,5% possuem alguma equipe de saúde bucal (ESB), 96,9% não tem habilitação como Centros de Especialidades Odontológicas (CEO). Os CEO são mais eficientes que as demais unidades (p < 0,001), mas há importante percentual que não cumpre as metas do Ministério da Saúde. Os municípios com CEO possuem maior população, mais ESB, menor cobertura potencial por estas e melhores IDH. Um significativo número de procedimentos especializados é realizado, especialmente em estabelecimentos de atenção básica. CEO são mais eficientes do que os não CEO, considerandose a média de procedimentos realizados. As metas de produção mínima são cumpridas por uma minoria de CEO.

The scope of this study was to describe and analyze specialized outpatient procedures in periodontics, endodontics and oral surgery performed in the State of Minas Gerais in 2010. Secondary data for the procedures performed in healthcare facilities and registered in the Information System of the Unified Health System were used. Descriptive and bivariate analysis was performed, considering p <0.05. 707,559 procedures were performed in 2,547 health units distributed in 693 (81%) counties in the State. Of these procedures, 55% are in the area of surgery, 28% in periodontics and 17% in endodontics. The units are predominantly public under municipal administration, 52.5% of which have an oral health team (OHT) and 96.9% have no qualification as Dental Specialty Centers (DSCs). DSCs are more efficient than the other units (p <0.001), but there is a significant percentage that fails to comply with the goals of the Ministry of Health. Municipalities that have DSCs have higher population, more OHTs, lower potential coverage and better HDI. A significant number of specialized procedures are performed in the State of Minas Gerais, especially in primary care settings. DSC establishments are more efficient than non-DSC, considering the average number of procedures. The minimum production goals are met by a minority of DSCs.

Análise da atenção secundária em odontologia no estado de Minas Gerais / Analysis of secondary care in oral health in the state of Minas Gerais

Este estudo descreveu e analisou os procedimentos especializados ambulatoriais nas áreas de periodontia, endodontia e cirurgia bucal em Minas Gerais, 2010. Utilizou-se dados secundários dos procedimentos realizados nos estabelecimentos de saúde e registrados no Sistema de Informação do Sistema Único de Saúde. A análise descritiva e bivariada foi realizada, considerando p menor 0,05...