Atenção odontológica especializada para pessoas com deficiência no Brasil: perfil dos centros de especialidades odontológicas, 2014 / Atención odontológica especializada para personas con discapacidad en Brasil: perfil de los centros de especialidades odontológicas, 2014 / Specialized dental care for people with disabilities in Brazil: profile of the Dental Specialty Centers, 2014

Objetivo: Descrever os serviços de atenção à saúde bucal para pessoas com deficiência, atendidas pela especialidade Odontologia para Pacientes com Necessidades Especiais (PNE). Métodos: Estudo transversal, com dados do Programa de Melhoria do Acesso e Qualidade dos Centros de Especialidades Odontológicas (PMAQ-CEO), 2014. Resultados: Dos 932 serviços avaliados, 89,8% contavam com atendimento a PNEs, 30,4% apresentavam acessibilidade física e 59,7% contavam com referência para atendimento hospitalar. A maioria garantia tratamento completo. São disponibilizadas 40h semanais de atendimento clínico a PNEs em 1/3 dos CEOs. Conclusão: A rede de cuidado para pessoas com deficiência encontra-se em formação e, apesar dos incentivos financeiros específicos, apresenta limitações. Os serviços precisam eliminar barreiras físicas e atitudinais para garantir acessibilidade universal. Protocolos baseados em classificação de risco são necessários, priorizando atendimento no CEO dos casos complexos, não atendidos na Atenção Básica e organizando a rede de cuidados em saúde bucal da pessoa com deficiência.

Objetivo: Describir los servicios de atención a la salud bucal para personas con discapacidad, atendidos por la especialidad Odontología para Pacientes con Necesidades Especiales (PNE). Métodos: Estudio transversal, con datos del Programa de Mejora del Acceso y Calidad de los Centros de Especialidades Odontológicas (PMAC-CEO), 2014. Resultados: Se evaluaron 932 servicios: 89,8% contaba con atención a los PNEs, 30,4% tenía accesibilidad física y 59,7% tenía referencia para atención hospitalaria. La mayoría garantía tratamiento completo. Sólo 1/3 ofrecían 40hs semanales de atención PNE. Conclusión: La red de atención para personas con discapacidades se está formando, y a pesar de los incentivos financieros específicos, tiene limitaciones. Los servicios necesitan eliminar las barreras físicas y de actitud para garantizar la accesibilidad universal. Protocolos basados en clasificación de riesgo son necesarios, priorizando la atención en el CEO de los casos complejos, no atendidos en la atención básica y organizando la red de atención en salud bucal de la persona con discapacidad.

Objective: To describe the oral health care services for people with disabilities treated within the Dentistry for Patients with Special Needs (PSN) specialty. Methods: This was a cross-sectional study with data from the Program for Improving Access and Quality of Dental Specialty Centers (PMAQ-CEO) in 2014. Results: Of the total of 932 services evaluated, 89.8% did provide care for PSNs, 30.4% had physical accessibility, 59.7% provided referral to hospital care and most guaranteed complete treatment. Only a third of the Dental Specialty Centers planned 40 or more hours a week for providing clinical care to PSNs. Conclusion: The care network for people with disabilities is being formed but, even with specific financial incentives, it has limitations. Services need to eliminate physical and attitudinal barriers to ensure universal accessibility. Protocols based on risk classification are necessary, prioritizing care at DSCs for complex cases not attended to in Primary Care and organizing the dental health care network for people with disabilities.

The transition from amalgam to other restorative materials in the U.S. predoctoral pediatric dentistry clinics.

Increased concerns about the safety of amalgam restorations in children have resulted in many dental schools emphasizing the teaching of alternative dental materials. This study investigated the current teaching of different dental materials for use in posterior teeth in the United States predoctoral pediatric dentistry programs. In 2011, the authors invited the chairs of the predoctoral pediatric dentistry departments in all accredited dental schools at that time (N = 57) to participate in an internet-based survey. Descriptive statistics were calculated to describe the frequency of using different restorative materials. Regression models were developed to explore the factors related to the use of dental restorations in predoctoral pediatric clinics. Among the 44 dental schools that responded (77% response rate), 74% used amalgam, and 93% used composite in primary posterior teeth. Glass ionomer was used by 61% of the schools in primary posterior teeth. Placing amalgam in primary posterior teeth was associated with programs that treated more 3-5-year-old patients (ß = .302, p < .043), whereas the use of glass ionomer was associated with having students serving at off-site satellite dental clinics (ß = .015, p < .012). In general, having departments with chairs who had positive attitudes towards Minimal Invasive Dentistry (MID) used composite (ß = .091, p < .0001) and glass ionomer (ß = 103, p < .0001) more frequently and were less likely to use amalgam (ß = -.077, p < .005) in primary posterior teeth. Although teaching MID concepts in predoctoral pediatric clinics in dental schools is increasing, the use of amalgam in posterior primary and permanent teeth is still widely practiced.

Clinical and Community-Based Education in U.S. Dental Schools.

This review of U.S. dental schools' clinical curricula suggests that the basic structure of clinical education has not changed significantly in the past 60 years, although important developments include the introduction of competency-based education and community-based clinical education. Most dental schools still have a two-year preclinical curriculum and a two-year clinical curriculum, and most schools still operate a large clinical facility where students receive the bulk of their clinical education and assessment for graduation. In those clinics, dental students are the main providers of patient treatment, with faculty serving in supervisory roles. In addition, a major portion of the entire dental curriculum continues to be dedicated to student education on the restoration of a single tooth or replacement of teeth. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Changes in university orthodontic care over a period of 20 years : Patient characteristics, treatment quality, and treatment costs.

AIM: The aim of the present study was to analyze whether there were changes in the severity of malocclusions of patients treated at the Department of Orthodontics, University of Giessen, Germany over a period of 20 years (1992-2012) and if the implementation of the KIG system (German index of treatment need) in 2001 had any effect on the patient cohort. Furthermore, the study aimed to analyze the influence of the severity of malocclusion on treatment quality and economic efficiency (relation payment per case/treatment effort). MATERIALS AND METHODS: The files of all 5385 patients admitted to the orthodontic department between 1992 and 2012 were screened and the following information was recorded: patient characteristics, treatment duration, KIG, treatment outcome, and costs. RESULTS: In the KIG period, patients were older, pretreatment malocclusions were more severe, treatment took longer, required more appointments, and did not achieve the same degree of perfection as in the pre-KIG period. Patients with a higher pretreatment KIG category had longer treatments and did not achieve the same degree of perfection as patients with lower KIG categories. Although total payment was slightly higher for the more severe cases, their cost-per-appointment ratio was significantly lower. CONCLUSION: In the present university department, a shift of the orthodontic care task towards more complex cases has occurred over the last 20 years. Generally the quality of orthodontic treatment was good, but it has been demonstrated that the higher KIG cases did not end up at the same level of excellence as the lower KIG cases. Furthermore, KIG 5 patients had a longer treatment duration, and required more appointments than lower KIG cases.

Redes integradas de servicios estomatológicos. El caso cubano / Integrated networks of dental services. The Cuban case

Introducción: Cuba exhibe una singular forma de organización de los servicios de salud, dentro de ellos, los servicios estomatológicos constituyen quizás una de las más exquisitas piezas del amplio arsenal de prestaciones a las que tiene acceso la población cubana. En el contexto latinoamericano no hay referentes de un sistema público de atención estomatológica, de cobertura universal, que haya desarrollado un conjunto de prestaciones integradas e integrales como el cubano. A partir de estas afirmaciones, surgen las siguientes interrogantes ¿Cumple la red de servicios estomatológicos cubana con los atributos de la integración que proponen los organismos internacionales? ¿En qué momento de integración se encuentra la red? ¿Cuáles serían los retos para el futuro?. Desarrollo: el desafío práctico de alcanzar los objetivos del Programa Nacional de Atención Estomatológica Integral a la Población dispone de un sistema integrado de prestación de servicios de salud, en el que se pueden identificar reservas de mejora en cuanto a un conjunto de atributos relacionados con la integración en lo referido a: la vinculación con los equipos básicos de salud del policlínico; la participación de la familia, comunitaria e intersectorial para el manejo de problemas de salud, entre otros. El modelo cubano integra todas las funciones inherentes a los sistemas sanitarios: prestación de servicios, rectoría y gestión, financiamiento y articulación. Conclusiones: la red de servicios estomatológicos cubana incorpora en su diseño e implementación los atributos de la integración que propone la Organización Panamericana de la Salud. No disponemos de información avalada científicamente sobre el nivel de integración que alcanza la red de servicios estomatológicos cubana ni el impacto de los fenómenos de integración/fragmentación sobre los servicios que se prestan. Se plantea como reto de futuro desarrollar investigaciones que evidencien el impacto de los fenómenos de integración/fragmentación en la red de servicios de estomatología(AU)

Introduction: Cuba has a unique way of organizing health services within them; dental services are perhaps one of the most exquisite pieces of the broad array of benefits to which the Cuban population has access. In the Latin American context there is no reference of a public dental care system with universal coverage, which has developed a set of integrated and comprehensive benefits such as Cuba. From these statements, the following questions arise: Does the Cuban network of dental services with the attributes of integration proposed by international organizations? What time is network integration? What are the challenges for the future? Development: the practical challenge of achieving the objectives of the National Program of Comprehensive Care for the Population Stomatology has an integrated health service delivery. Its reserves of improvement system can be identified as a set of attributes related to: integration linking with basic equipment health clinic; the participation of the family, community and intersectoral management of health problems, among others. The Cuban model integrates all the functions inherent to health systems: service delivery, stewardship and management, financing, and coordination. Conclusions: Cuban network of dental services incorporated in its design and implementation attributes of integration proposed by the Pan American Health Organization. No scientifically supported information is available on the level of integration the Cuban network of dental services reaches, nor the impact of the phenomena of integration/fragmentation of the services provided. It poses as a challenge for the future, to conduct a research that demonstrates the impact of the phenomena of integration/fragmentation in stomatology services network(AU)

A prática da magnificação na Odontologia contemporânea / Magnification in contemporary Dentistry

A tecnologia trouxe a possibilidade de superação das limitações humanas na prática clínica. O aumento do conforto pós-operatório para o paciente só pôde ser viabilizado com o bem-estar do profissional que realiza múltiplas intervenções clínicas diárias. O cansaço visual pode ser minimizado com o uso de algum tipo de magnificação. O refinado trato na manipulação dos tecidos periodontais nas microcirugias plásticas, acompanhada da melhoria na cicatrização e no resultado pós-operatório, por si só, já premiariam o uso da magnificação. Entretanto, os resultados na Endodontia, na Dentística Operatória e na Prótese consagraram o microscópio como uma alternativa que merece maior divulgação na prática clínica contemporânea. Logo, este trabalho tem o objetivo de ilustrar essa tecnologia aos clínicos que querem aumentar sua produtividade e investir em conforto para seus pacientes e para a própria carreira.

Puesta el día en iluminación / Update in lighting

A la hora de planificar la iluminación en una clínica dental, es muy importante lograr la funcionalidad de un buen sistema sin olvidar la estética, ni los posibles riesgos derivados de la misma. La iluminación en la clínica depende de varios factores los cuales interaccionan al unísono, es por tanto esencial prestarles una completa atención y cuidado minucioso, para conseguir así la optimización al completo de nuestro trabajo (AU)

When planning the lighting in a dental clinic, it is very important to achieve the functionality of a good system without forgetting aesthetics, or the possible risks that may be derived from it. Lighting in the clinic depends on various factors which interact simultaneously; therefore, it is essential to give it full attention and meticulous care, in order to attain the complete optimization of our work (AU)

Evolution of dental school clinics as patient care delivery centers.

Dental school clinics, originally envisioned as closely similar to private practice, evolved instead as teaching clinics. In the former, graduate and licensed dentists perform the treatment while undergraduate dental students are assigned treatment within their capabilities. In the latter, dental students provide the treatment under faculty supervision. It is generally recognized that the care provided by the teaching clinics is inefficient. However, in the last quarter of the twentieth century, dental school clinics began to pay much more attention to how treatment is rendered. The comprehensive care movement and quality assurance systems are leading towards more efficient patient-centered care. Case studies at the University of Maryland, Columbia University, and University of Louisville describe activities to make their clinic programs more efficient and patient-friendly. This article explores whether the potential exists for faculty to take a direct patient care delivery role in dental clinics in order for those clinics to become efficient patient care delivery systems as originally envisioned in the early part of the twentieth century.

Adaptação transcultural de instrumentos para mensurar ansiedade e comportamento em clínica odontológica infantil / Cross-cultural adaptation of instruments to assess anxiety and behavior in children's dental treatment

O artigo traz uma adaptação dos instrumentos Dental Anxiety Scale (DAS) e da Behavior Rating Scale para utilização no Brasil. A adaptação transcultural desses instrumentos constou das seguintes etapas: tradução dos instrumentos originais para o português, retrotradução, avaliação do comitê, adaptação cultural, validação de face e validação de conteúdo, originando, respectivamente, a Versão Brasileira da Escala de Ansiedade de Norman Corah e a Versão Brasileira da Escala de Padrão Comportamental de Venhan. Estas duas escalas foram consideradas válidas, confiáveis e facilmente integráveis em atividades clínicas e de pesquisa, podendo ser utilizadas em conjunto numa avaliação de relação entre ansiedade dos pais e comportamento das crianças.

Clinical quality assurance surveillance and targeted interventions: managing unfavorable trends in a dental school clinic.

Dental schools establish quality assurance (QA) programs that are intended to improve patient care, comply with requirements of liability carriers and regulatory agencies, and maintain accreditation. Data collection, trend analysis, and interventions are typically used in QA programs to monitor and improve compliance. The purpose of this article is to discuss unfavorable trends and examine the effect of targeted interventions in three clinical operations: infection control, removable prosthodontics, and case reviews of students' patient care in progress (interim case reviews) at a U.S. dental school. Infection control compliance was evaluated and interventions were implemented beginning in 2002 to correct unfavorable trends in two protocols: placement of students' mobile supply cart and the use of overgloves. A predelivery esthetic consent was introduced in spring 2004 to decrease esthetic failures in removable prosthodontics. For interim case reviews, two areas received interventions going back to 2003: reevaluation following initial periodontal therapy and orthodontic screening. The data presented are not meant to show conclusive success of particular interventions, but to display broad trends and suggest methods to manage quality assurance parameters. These trends suggest we had better success with the interventions that were simple, valuable, measurable, and repeatable than with interventions that less fit these criteria.

Evolution of dental school clinics as patient care delivery centers.

Dental school clinics, originally envisioned as closely similar to private practice, evolved instead as teaching clinics. In the former, graduate and licensed dentists perform the treatment while undergraduate dental students are assigned treatment within their capabilities. In the latter, dental students provide the treatment under faculty supervision. It is generally recognized that the care provided by the teaching clinics is inefficient. However, in the last quarter of the twentieth century, dental school clinics began to pay much more attention to how treatment is rendered. The comprehensive care movement and quality assurance systems are leading towards more efficient patient-centered care. Case studies at the University of Maryland, Columbia University, and University of Louisville describe activities to make their clinic programs more efficient and patient-friendly. This article explores whether the potential exists for faculty to take a direct patient care delivery role in dental clinics in order for those clinics to become efficient patient care delivery systems as originally envisioned in the early part of the twentieth century.

Prevalência das alterações da normalidade e lesões da mucosa bucal em pacientes atendidos nas Clínicas Integradas de Atenção Primária (CIAPS) da Faculdade de Odontologia da UFMG / Development alterations and lesions of the oral mucosa in patients assisted in the Integrated Clinics of Primary Attention (CIAPS) of the School of Dentistry of UFMG

O objetivo deste trabalho foi realizar um levantamento da prevalência das alterações de normalidade e lesões (ANLs) da mucosa bucal em pacientes atendidos nas Clínicas Integradas de Atenção Primária (CIAPS) da Faculdade de Odontologia da UFMG. Simultaneamente, realizou-se um levantamento de alterações sistêmicas e hábitos deletérios. Também foi verificado o reconhecimento das ANLs pelos alunos que fazem atendimento nas CIAPs, através do registro das alterações nos prontuários. Os resultados mostram uma diversidade de ANLs, sendo as mais freqüentes hiperqueratose (19,6 por cento), as manchas melânicas (16,8 por cento), língua saburrosa (8,8 por cento), grânulos de Fordyce (8,8 por cento) e úlcera traumática (8,4 por cento). Quanto às alterações sistêmicas, as mais freqüentes foram hipertensão (8,8 por cento), distúrbios neurológicos (7 por cento), cardiopatias diversas, insuficiência renal e diabetes (2,3 por cento cada). Os hábitos deletérios mais prevalentes foram etilismo (27 por cento) e tabagismo (22,8 por cento). Das ANLs encontradas, 21,6 por cento constavam nos prontuários dos pacientes e 50 ANLs relatadas nos prontuários dos pacientes, não foram confirmados pelo exame físico durante a pesquisa. As ANLs são frequentes e o frequentes e o cirurgião-dentista deve estar preparando para reconhecê-las e diagnosticá-las.

Perfil do atendimento e dos pacientes usuários das clínicas de exodontias da Faculdade de Odontologia da Universidade Federal de Minas Gerais (UFMG) / A study about patients attending in extraction clinics from the Dentistry School at Universidade Federal de Minas Gerais- Brazil

Com o objetivo de estudar o atendimento nas clínicas de exodontia da Faculdade de Odontologia da UFMG, selecionou-se 198 pacientes atendidos durante o período letivo de 2002, sendo 44,6 por cento do sexo masculino. As médias de idade para os sexos masculino e feminino foram respectivamente , de 38,7 por cento (dp +-16,1) e 35,1 (+-13,2) anos sem diferença estatisticamente significativa (T=1,68; P=0,09). Enquanto 43,4 por cento dos pacientes não concluíram o primeiro grau, apenas 17,2 por cento concluíram o segundo grau e 8,6 por cento declaram-se analfabetos. As atividades profissionais mais citadas foram: estudantes (16,2 por cento), técnicos de nível médio (16,2 por cento) e profissionais de serviços gerais e mão de obra não especificada (13,1 por cento). Entre os homens as atividades mais relacionadas foram: trabalhadores da construção civil e assemelhados (20,5 por cento) e os técnicos de nível médio (20,5 por cento). Entre as mulheres as atividades do lar não remuneradas (26,4 por cento) e as trabalhadoras de serviços domésticos (15,3 por cento) foram as profissões mais relacionadas. Os molares permanentes foram os dentes mais extraídos e a cárie e suas seqüelas o principal motivo para as exodontias. Não ocorreram complicações trans e pós-operatórias e, cerca de 87,0 por cento dos atendimentos e a maioria dos pacientes (66,2 por cento) não relatou dor pós-operatória. Os resultados permitem cocluir que apesar dos avanços da Odontologia ainda é grande o número de dentes extraídos em função da cárie e suas seqüelas e da falta de condições para a realização de um tratamento conservador. O número de exodontias poderia ser reduzido mediante um programa eficaz de prevenção, sendo necessário instituir-se protocolos para atendimento na FOUFMG

Urgencias médicas en el gabinete dental. Diagnóstico y tratamiento / No disponible

A lo largo de los años, la Sociedad ha vinculado el tratamiento dental con procedimientos más o menos desagradables pero inocuos. En cambio, ante el avance tecnológico, la agresividad de ciertas técnicas y la utilización de nuevos fármacos, es más frecuente la posibilidad de presentación de situaciones de emergencia. Existen pocos trabajos sobre el estudio de estos cuadros y todos ellos pertenecientes a países anglosajones. Los objetivos (..) (AU)

Through out many years society has associated dental treatment with procedures which are unpleasant, but innocuous. Despite the fact of advance in technology, the aggessivity of certain techniques and the use of new drugs there still (..) (AU)