Experiências de acesso à saúde bucal de mulheres em situação de rua / Experiences of access to oral health of homeless women

RESUMO O objetivo deste estudo foi compreender a experiência de acesso a ações e serviços de saúde bucal de mulheres em situação de rua na cidade de Teresina, Piauí. Pesquisa qualitativa, norteada pelo paradigma interpretativo, desenvolvida com mulheres em situação de rua acompanhadas por instituições de referência. Os dados foram obtidos mediante entrevistas semiestruturadas, gravadas e transcritas. As análises foram baseadas na hermenêutica de Hans-Georg Gadamer (2015) associada às contribuições de Paul Ricoeur (1976). Foram realizadas 13 entrevistas, identificando-se duas unidades de significado: Sermulher em situação de rua; e Acesso a ações e serviços de saúde bucal. Diversas problemáticas cruzam as vidas das mulheres em situação de rua, sendo agravadas pela condição de gênero. Precárias condições de saúde bucal e dificuldade de acesso a ações e serviços de saúde bucal foram indicadas nas narrativas. É imperativo que as políticas existentes sejam postas em prática e contemplem as peculiaridades femininas. Apesar de todos os cirurgiões-dentistas da rede serem responsáveis pela atenção à saúde bucal das pessoas em situação de rua, a presença de um membro da saúde bucal dentro da equipe de consultório da rua foi apontada como necessária.

ABSTRACT This study aimed to understand the experience of access to oral health initiatives and services of homeless women in the city of Teresina, Piauí. A qualitative research, guided by the interpretative paradigm, was conducted with homeless women who were under the care of specialized institutions. The data were obtained using semi-structured interviews, which were recorded and transcribed. The analyses of the interviews were based on the hermeneutics of Hans-Georg Gadamer (2015), combined with the contributions of Paul Ricoeur (1976). Thirteen interviews were conducted, identifying two units of meaning: Being-woman and homeless; and Access to oral health initiatives and services. Poor oral health conditions and difficulty in accessing oral health initiatives and services were reported by the participants. Those problems were aggravated by the status of being a woman. The existing health policies should be put into practice and should, additionally, take into account female peculiarities. Although the public health system is available for the oral health care of homeless people, the Street Clinic service would benefit from the participation of an oral health professional.

Odontologia para Pacientes com Necessidades Especiais no ensino de graduação: percepção de discentes e docentes em uma instituição do Piauí e um panorama brasileiro / Dentistry for Special Needs Patients in undergraduate teaching: perception of students and professors at a university in Piaui and a Brazilian overview

A inexperiência do graduando em Odontologia no manejo de Pacientes com Necessidades Especiais (PNE) gera lacunas na formação e pode contribuir para a barreira de acesso desses indivíduos aos serviços de saúde bucal. Este estudo analisou a percepção de discentes e docentes do curso de Odontologia da Universidade Federal do Piauí (UFPI)sobre a inclusão de atendimento a PNE no ensino de graduação e o panorama nacional da oferta de disciplina de PNE na estrutura curricular de cursos de Odontologia. Foi realizado um estudo transversal, descritivo e exploratório, com aplicação de questionários a discentes e docentes do curso de Odontologia da UFPI. As matrizes curriculares dos cursos foram consultadas em endereços eletrônicos institucionais. Foi realizada análisedescritiva dos dados e teste Exato de Fisher foi aplicado. A maioria dos discentes relataram nunca ter atendido um PNE (54,8 %) e,destes, 67,7% não se sentem preparados para este atendimento. A maioria dos discentes (84,7%) e docentes (53,8%) aprova a obrigatoriedade da disciplina de PNE na estrutura curricular. Insegurança foi a reação mais comum dos discentes ao atendimento odontológico fictício a um paciente PNE. Entre os docentes participantes do estudo, 73,1% informaram já ter atendido PNE. Em 67,8% dos cursos de Odontologia pesquisados há oferta de disciplina de PNE. Em conclusão, a ausência de atendimento a PNE gera insegurança aos graduandos em Odontologia. A inclusão do tema PNE na matriz curricular é apoiada por discentes e docentes. A disciplinaestá presente na maioria dos cursos de Odontologia do Brasil (AU).

Dentistry undergraduates do not acquire much experience managing Patients with Special Needs (PSN) during their university training. This knowledge deficit contributes to the situation where PSNs face barriers to accessing oral health services. This study was a cross-sectional, descriptive and exploratory study about the perception of Dentistry students and professors at the Federal University of Piaui (UFPI -Brazil) on whether care of PSN should be included in their course. The reactions ofstudents facing a simulated situation of dental care for PSN was also analyzed. A survey of the situation regarding PSN inclusion at other universities in Brazil was alsocarried out. Professors and students filled out questionnaires and information regarding university curriculums was collected from their websites. Descriptive data analysis was performed, and Fisher's exact test was applied. Most UFPI students reported never having treated a PSN (54.8%) and, of these, 67.7% did not feel confident to providethis treatment. Most professors (73.1%) reported having treated PSN. Most students (84.7%) and professors(53.8%) agree that Dentistry for PSN should be mandatory in the curricular structure. Lack of confidencewas the most common reaction of students to a simulation ofdental care for a PSN. Dentistry for PSN is part of the curriculum of 67.8% of the Dentistry courses surveyed. In conclusion, the lack of Dentistry for PSN during student training can makedentists-to-be unsure about how to treat PSN in real-life situations. The inclusion of dental care for PSN in the curriculum is supported by students and teachers. The topic is present in most Dentistry courses in Brazil (AU).

Prevalência e fatores associados a defeitos de desenvolvimento do esmalte em crianças de 5 anos de idade matriculadas em creches na cidade de Teresina, Brasil / Prevalence and factors associated with developmental defects of enamel in five-year-old children enrolled in preschools in the city of Teresina, Brazil

Resumo Introdução Crianças com defeitos de desenvolvimento de esmalte (DDE) são mais suscetíveis à hipersensibilidade dentinária, maloclusões e dificuldades relativas à adesão de materiais restauradores. O conhecimento sobre a prevalência de DDE e seus fatores associados permite aos profissionais obter maior compreensão desse problema de saúde bucal, minimizando, dessa forma, as sequelas e melhorando a saúde bucal e a qualidade de vida dos indivíduos afetados. Objetivo Determinar a prevalência de DDE e seus fatores associados na dentição decídua. Método Trata-se de estudo transversal com amostra probabilística de 566 pré-escolares de 5 anos de idade, matriculados em creches públicas e privadas de Teresina, Piauí, Brasil. Foi aplicado questionário socioeconômico e de história médica da criança aos responsáveis. Os exames clínicos foram conduzidos por um único examinador (kappa = 0,93 para DDE e 0,86 para cárie) que utilizou os índices DDE modificado e ceo-d. Foi realizada a análise descritiva dos dados, além dos testes qui-quadrado e exato de Fisher e a regressão de Poisson, considerando como significativo p ≤ 0,05. Resultados A prevalência de DDE foi de 33,7%. A média de dentes com DDE por criança foi de 3,12 ± 2,23. O tipo mais prevalente de DDE foi opacidade demarcada (9,5%). Os segundos molares superiores foram os dentes mais afetados (11,9%). Houve associação entre DDE e estudar em creche pública (p = 0,026) e cárie (p = 0,012). Crianças com experiência de cárie apresentaram maior prevalência de DDE (RP: 1,29; IC95%: 1,01-1,64). Conclusão A prevalência de DDE na dentição decídua foi de 33,7% e se mostrou associada à experiência de cárie.

Abstract Background Children with Developmental Defects of Enamel (DDE) are more susceptible to dentin hypersensitivity, malocclusions, and difficulties related to the adhesion of restorative materials. Knowledge about the prevalence and factors associated with DDE allows professionals to gain a greater understanding of this oral health problem, minimizing sequelae, improving oral health and quality of life of affected individuals. Objective To determine the prevalence and factors associated with DDE in primary dentition. Method This is a cross-sectional study assessing a random sample of 566 preschool five-year-old children, enrolled in public and private preschools in Teresina, Piauí, Brazil. It was applied the socioeconomic and medical history of the child questionnaire for the parents or guardians. Clinical examinations were conducted by a single examiner (kappa = 0.93 for DDE and 0.86 for caries) that used the modified DDE index and dmft. Descriptive analysis, chi-square and Fisher's exact tests, and Poisson regression were performed, considering significant p ≤ 0.05. Results the prevalence of DDE was 33.7%. The mean DDE teeth per child was 3.12 ± 2.23. The most prevalent type of DDE was demarcated opacity (9.5%). The second molars were the most affected teeth (11.9%). There was an association between DDE and study at public preschool (p = 0.026) and dental caries (p = 0.012). Children with experience of caries were more likely to DDE (PR: 1.29; 95% CI: 1.01 to 1.64). Conclusion prevalence of DDE in the primary dentition was 33.7% and was associated with caries experience.

Factors associated with oral health-related quality of life in homeless persons: a cross-sectional study.

This study aimed to evaluate the clinical and sociodemographic factors associated with the oral health-related quality of life (OHRQoL) of homeless persons. A cross-sectional study was conducted, with participants (n = 176) attending a Specialized Reference Center for the Homeless Population in Teresina, Brazil. Dental caries (DMFT index, WHO criteria), periodontal disease (CPI index), and the consequences of untreated caries (PUFA index) were measured by a single calibrated examiner (Kappa ≥0.83). Sociodemographic, oral health, and OHRQoL (OHIP-14) data were obtained through interviews. Data analysis included descriptive statistics and Poisson regression, with a significance level of 5%. Most of the participants were male (86.4%) and from the age group of 30 to 43 years (52.2%). Mean DMFT was 11 (SD ± 6.9) and mean total PUFA score was 1.2 (SD ± 2.2). Most of the participants (88.6%) had dental calculus and 8.5% and 1.7% of the sample had gingival bleeding and periodontal pocket > 3.5mm, respectively. The highest prevalence of negative impact in the OHRQoL was associated with females (1.4 (95%CI 1.1-1.7)), low educational level (2.0 (95%CI 1.3-3.0)), caries (1.6 (95%CI 1.1-2.6)), fistulas (1.9 (95%CI 1.3-3.1)), gingival bleeding (1.7 (95%CI 1.1- 2.7)), dental calculus (1.8 (95% CI 1.3-2.5)), periodontal pockets > 3 mm (1.5 (95%CI 1.1-2.0)), and need for extraction (2.3 (95%CI 1.1-5.0)). In conclusion, the negative impact on the OHRQoL of homeless persons was associated with low educational level, presence of decayed teeth, gingival bleeding, and dental calculus.

Factors associated with oral health-related quality of life in homeless persons: a cross-sectional study

Abstract This study aimed to evaluate the clinical and sociodemographic factors associated with the oral health-related quality of life (OHRQoL) of homeless persons. A cross-sectional study was conducted, with participants (n = 176) attending a Specialized Reference Center for the Homeless Population in Teresina, Brazil. Dental caries (DMFT index, WHO criteria), periodontal disease (CPI index), and the consequences of untreated caries (PUFA index) were measured by a single calibrated examiner (Kappa ≥0.83). Sociodemographic, oral health, and OHRQoL (OHIP-14) data were obtained through interviews. Data analysis included descriptive statistics and Poisson regression, with a significance level of 5%. Most of the participants were male (86.4%) and from the age group of 30 to 43 years (52.2%). Mean DMFT was 11 (SD ± 6.9) and mean total PUFA score was 1.2 (SD ± 2.2). Most of the participants (88.6%) had dental calculus and 8.5% and 1.7% of the sample had gingival bleeding and periodontal pocket > 3.5mm, respectively. The highest prevalence of negative impact in the OHRQoL was associated with females (1.4 (95%CI 1.1-1.7)), low educational level (2.0 (95%CI 1.3-3.0)), caries (1.6 (95%CI 1.1-2.6)), fistulas (1.9 (95%CI 1.3-3.1)), gingival bleeding (1.7 (95%CI 1.1- 2.7)), dental calculus (1.8 (95% CI 1.3-2.5)), periodontal pockets > 3 mm (1.5 (95%CI 1.1-2.0)), and need for extraction (2.3 (95%CI 1.1-5.0)). In conclusion, the negative impact on the OHRQoL of homeless persons was associated with low educational level, presence of decayed teeth, gingival bleeding, and dental calculus.