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Objectives This study examines the relationships between socio-economic status, psychosocial factors, health-related behaviours and the incidence of dental caries amongst 12-year-old schoolchildren living in deprived communities in Manaus, Brazil. Methods A longitudinal study involving 312 children aged 12 years was conducted in the city of Manaus, Brazil. Baseline data including socio-economic status (number of goods, household overcrowding, parents’ schooling, family income), psychosocial factors (sense of coherence [SOC-13], social support [Social Support Appraisals questionnaire]) and health-related behaviours (frequency of toothbrushing, sugar consumption, sedentary behaviour) were collected through structured questionnaires. The number of decayed teeth was clinically assessed at baseline and one-year follow-up. A hypothesised model evaluating the direct and indirect pathways between the variables was tested using confirmatory factor analysis and structural equation modelling. Results The incidence of dental caries at the one-year follow-up was 25.6%. Sugar consumption (β = 0.103) and sedentary behaviour (β = 0.102) directly predicted the incidence of dental caries. A higher socio-economic status was directly linked with lower sugar consumption (β = -0.243) and higher sedentary behaviour (β = 0.227). Higher social support directly predicted lower sugar consumption (β = -0.114). Lower socio-economic status (β = -0.046) and lower social support (β = -0.026) indirectly predicted the incidence of dental caries via sugar consumption and sedentary behaviour. Conclusions In the population studied, sugar consumption and sedentary behaviour are meaningful predictors of the incidence of dental caries amongst schoolchildren living in deprived communities. Indirect pathways of lower socio-economic status and low social support with dental caries incidence via sugar consumption and sedentary behaviour were detected. These findings should be considered in oral interventions and oral health care policies to prevent dental caries amongst children living in deprivation. Clinical significance Social conditions, social support, sedentary behaviour and sugar consumption directly influence dental caries in children. Paid open access UNIT agreement

Os livros didáticos são considerados ferramentas eficazes para promover a saúde bucal no ambiente escolar, representando importantes meios para auxiliar a condução do processo ensino-aprendizagem, bem como facilitar a memorização dos conhecimentos, favorecer a aquisição de competências disciplinares ou transversais e a apropriação de habilidades. O objetivo do estudo foi avaliar o conteúdo de saúde bucal nos livros didáticos de Ciências aprovados pelo Programa Nacional do Livro e do Material Didático (PNLD) do Ensino Fundamental I adotados em uma escola municipal da cidade de Manaus-AM. Uma análise de conteúdo temática simples proposta por Bardin (1979) foi realizada com base nos livros didáticos de Ciências: Ápis – Descobrir o mundo (1°, 2° e 3° ano) e Projeto Buriti (4° e 5° ano), sendo as informações coletadas registradas em uma ficha previamente elaborada. Os temas selecionados foram: A - relação da saúde geral com a bucal, função dos dentes e dentição decídua/permanente; B - higiene bucal e instrumentos para sua realização; C – doenças bucais (cárie e gengivite) e seus determinantes e; D - uso de fluoretos. Por conseguinte, qualificados em termos de satisfatoriedade, aceitabilidade, insatisfatoriedade e inexistência, segundo critérios científicos atuais. Nos livros analisados, observou-se escassez quanto aos conteúdos referentes à saúde bucal, havendo a predominância do critério de inexistência, seguido do critério de insatisfatoriedade. Apenas o livro do 2º ano apresentou conteúdo satisfatório para a categoria A, abordando a importância da saúde bucal e troca de dentes decíduos para permanentes. Conclui-se que conteúdos referentes à saúde bucal foram encontrados de forma escassa e até inexistentes em alguns livros, necessitando-se de uma reavaliação deste material. Recomenda-se que os responsáveis pelo conteúdo dos livros didáticos e os profissionais da saúde estejam alinhados quanto ao desenvolvimento dos temas para que as crianças possam ser providas de uma educação em saúde bucal adequada no ambiente escolar.

BACKGROUND The possible link between dental status and school performance has been investigated. The influence of the clinical consequences of untreated dental caries in this association, however, has been minimally explored. AIM To assess the relationship between clinical consequences of untreated dental caries and school performance in adolescents, and to examine the demographics and socioeconomic status pathways by which clinical consequences of untreated dental caries is associated with school performance. DESIGN A cross-sectional study involving 363 low-income school adolescents was conducted in the city of Manaus, Brazil. Dental clinical measures were registered by five calibrated examiners to evaluate dental caries experience (decayed, missing, and filled teeth index [DMFT]) and clinical sequelae of dental caries (PUFA/pufa index). School performance was assessed using school grade history obtained from official records. Statistical analysis was conducted using pathway analysis to estimate beta coefficients (β) of the direct and indirect effects between variables. RESULTS DMFT and PUFA/pufa mean were 1.93 and 0.30, respectively. PUFA/pufa scores (β = -0.19) and male sex (β = 0.35) directly predicted poor school performance. DMFT was indirectly linked to poor school performance via PUFA/pufa scores (β = -0.03). CONCLUSIONS Dental caries and clinical consequences of dental caries were important predictors of poor school performance in low-income adolescents via direct and indirect effects.

Introdução: Instalar um implante na região posterior da maxila e da mandíbula sempre foi muito crítico devido à baixa qualidade óssea e quantidade óssea reduzida, encontradas em vários casos clínicos, devido as reabsorções ósseas. Objetivos: Este estudo tem como objetivo avaliar na literatura médica vigente alguns casos onde foram instalados implantes curtos em região posterior. Metodologia: Foi realizado uma varredura nos portais de indexação Google acadêmico, Scielo, Pubmed e livros de autores especialistas na área de implantodontia, portanto a modalidade da pesquisa é bibliográfica tendo um objetivo exploratório, onde foi feita uma revisão de literatura desde as primeiras publicações que abrangem o tema até as pesquisas mais recentes. Resultados: Foram encontrados mais de 10.000 artigos referentes ao tema e 17 foram escolhidos para servirem como base deste artigo. Conclusão: Os implantes curtos oferecem uma alternativa de tratamento menos traumática nos casos de pouca altura óssea e limitações anatômicas.

Background/Aims: This study evaluated the relationships of clinical consequences of untreated dental caries, individual characteristics, and environmental factors on self-reported oral health measures in adolescents. Methods: A follow-up prevalence study was conducted involving 406 twelve-year-old adolescents selected from public schools in the eastern area of the city of Manaus, Brazil. Baseline data included clinical consequences of untreated caries (PUFA/pufa index), DMFT, sociodemographic characteristics (sex, parental schooling, and family income), psychosocial factors (sense of coherence [SOC-13 scale], oral health beliefs and self-esteem [Rosenberg Self-Esteem Scale]), and social support (SSA questionnaire). Oral health-related quality of life (OHRQoL [CPQ11–14]) and self-rated oral health were assessed at the 6-month follow-up. Structural equation modelling was used to explore the relationships between variables according to the Wilson and Cleary model. Results: The prevalence of PUFA/pufa was 17.8% and mean DMFT was 1.5. The number of teeth with clinical consequences of untreated caries predicted poor self-rated oral health at the 6-month follow-up. Low parental schooling predicted low family income and clinical consequences of untreated dental caries. Psychosocial factors predicted OHRQoL directly and self-rated oral health indirectly. OHRQoL was linked to self-rated oral health. Clinical consequences of untreated dental caries mediated the relationship of parental schooling with OHRQoL and self-rated oral health. OHRQoL mediated the relationship of psychosocial factors and sex with self-rated oral health. Clinical consequences of untreated dental caries was associated with adolescents’ self-rated oral health. Furthermore, the former was an important mediator on the link between low parental education and adolescents’ self-reported oral health measures. Conclusions: Socioeconomic status, psychosocial factors, and social support were related to OHRQoL and self-rated oral health via direct and indirect pathways.

Background To examine the role of dental pain, sense of coherence (SOC) and social support on the relationship between dental caries and oral health-related quality of life (OHRQoL) in children aged 12 years. Methods A cross-sectional study involving 400 schoolchildren selected from public schools in a socioeconomically disadvantaged region in the city of Manaus, Brazil was carried out. The predictors of OHRQoL were selected according to the Wilson and Cleary theoretical model, including number of decayed teeth and its clinical consequence (component D of the DMFT index and PUFA/pufa index), dental pain (symptom status), and SOC and social support (individual and environmental characteristics). Statistical analysis was conducted through structural equation modelling and multivariable negative binomial regression. The significance level established for all analyses was 5%. Results Number of dental caries was indirectly linked with OHRQoL (β = 0.19, 95% CI 0.11/0.29) through dental pain, SOC and social support. Clinical consequences of untreated caries directly predicted poor OHRQoL (β = 0.12, 95% CI 0.01/0.23). Dental pain, SOC and social support did not moderate the effect of dental caries measures on OHRQoL. Conclusion Our findings suggest the role of dental pain, SOC and social support as mediator factors on the link between dental caries and OHRQoL. Tackling dental caries along with psychosocial factors may attenuated the impact of oral health on OHRQoL in children.

Background Evidence on the possible influence of social and psychosocial factors on gingival status in socially disadvantaged children is scarce. The aim of this study is to assess the relationships among socioeconomic status, pattern of dental visits, self-esteem, oral health beliefs, toothbrushing frequency, oral hygiene effectiveness, and gingivitis in low social status adolescents. Methods A cross-sectional study was performed involving 406 12-year-old students recruited in Manaus, Brazil. Socioeconomic status (family income, parent's schooling, number of goods, and household crowding), self-esteem, oral health beliefs, and frequency of toothbrushing were collected through self-completed questionnaires. Gingival status (bleeding on probing) and oral hygiene effectiveness (dental calculus) were evaluated by calibrated dentists through oral examinations. Structural equation modeling assessed the direct and indirect relationships between variables guided by a theoretical model. Results The prevalence of gingivitis was 77.6%. Worse socioeconomic status and poor oral hygiene effectiveness directly predicted gingival bleeding. Socioeconomic status was also linked to toothbrushing frequency. Positive oral health beliefs and higher self-esteem predicted higher frequency of toothbrushing. The latter was directly linked to greater oral hygiene effectiveness. Oral health beliefs and self-esteem indirectly predicted gingival bleeding via toothbrushing frequency and oral hygiene effectiveness. Conclusion The present findings suggest the importance of socioeconomic status and psychosocial factors on gingival status in underprivileged adolescents. Poor oral hygiene mediated the associations between psychosocial factors and gingival status.

Este artigo relata a experiência de uma Faculdade de Odontologia durante o processo de construção e implementação de um novo projeto pedagógico (PP). O PP foi reformulado desde a caracterização do curso com as discussões sobre perfil de egresso, passando pela estrutura de funcionamento, objetivos, matriz curricular, estágios e concepção metodológica. Durante 12 meses foram utilizadas diversas ferramentas para sensibilização do corpo docente, incluindo a realização de semanas pedagógicas, oficinas, encontros pedagógicos e discussões nas assembleias docentes. O novo currículo foi implementado em 2012 evidenciando a interdisciplinaridade, a formatação de ambulatórios integrados e um estágio curricular obrigatório que compreende mais de 40% da matriz curricular entre atividades intra e extramuros. Dificuldades foram encontradas durante a implementação e a comunidade acadêmica buscou ferramentas para minimizá-las, fazendo com que o projeto continue dinâmico e amadureça a cada ano.

Studies show a worse oral health condition in institutionalized aged, when compared to non-institutionalized aged. Most of older people who residing in Long-Term Institutions for the aged (ILPI) have poorer oral hygiene, periodontal impairment and, therefore, greater tooth loss. This study aimed to investigate the oral health of institutionalized older people in the city of Manaus-AM, through secondary data from the medical records of an ILPI. A total of 117 medical records were investigated, with a predominance of male individuals (58.11%), whose age ranged from 60 to 107 years, who studied, on average, for 3.83 (± 3.85) years. There was a predominance of single individuals (77.7%) and those receiving retirement (55.5%). Regarding oral health, 69.3% of the individuals were edentulous. The mean DMFT-d was 29.3 (± 5.11). Upper and lower denture needs were observed in 77.7% and 82.5% of the sample, respectively. The retirement variable was the only one to present a limit of statistical significance in the association with the CPO-D, indicating that individuals who receive retirement have a lower average of the CPO-D index (p = 0.05).

OBJECTIVES: To examine the association of contextual and individual determinants with non-utilization of dental services among Brazilian adults. METHODS: Data were from adults aged 35-44 years (N = 7,265) from the 2010 Brazilian Oral Health Survey (SB Brasil Project). Non-utilization of dental services was assessed whether the individual has never had a dental visit over the whole life time. Independent variables were selected according to Andersen's behavioral model. Contextual variables included Human Development Index-longevity (HDI-Longevity) (predisposing demographic), HDI-Education and Gini index (predisposing social), integration of oral health teams into Primary Care (enabling health policy), and HDI-Income (enabling financing). Individual data were age and sex (predisposing demographic), ethnicity and schooling (predisposing social), family monthly income (predisposing enabling), perceived dental treatment (perceived need), and decayed teeth (evaluated need). The relationship of contextual and individual variables with non-utilization of dental services was assessed through multilevel logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (95% CI). RESULTS: The prevalence of non-utilization of dental services was 4.7 percent. Adults living in cities with high HDI-Income were less likely to never have a dental visit. The odds of non-utilization of dental services were lower for adults living in cities with high HDI-Longevity. Sex, skin color, dental treatment needs, poor socioeconomic characteristics, perceived dental treatment needs, and decayed teeth were also associated with non-utilization of dental services. CONCLUSIONS: The results suggest that contextual enabling and predisposing factors, individual sociodemographic, and needs-related characteristics influence non-utilization of dental services by Brazilian adults.

To determine the anticaries potential of toothpastes distributed by the primary health care public clinics (UBS) of Manaus, AM.Ninety-nine tubes of toothpaste from four commercial brands were collected from October 7, 2019 to October 11, 2019 in 16 UBS. They were assigned a code by brand and source UBS. According to the information on the packaging, the four brands and their batches were formulated with sodium monofluorophosphate (Na2FPO3) and most (91%) had calcium carbonate (CaCO3) as an abrasive. We determined the concentrations of total fluoride (TF = TSF + InsF) and total soluble fluoride (TSF = F ions- or FPO32-), to certify whether they were in compliance with resolution ANVISA RDC No. 530 (maximum of 1,500 ppm TF) and whether they had anticaries potential (minimum of 1,000 ppm TSF). The analyses were performed with a ion- specific electrode.The concentrations (ppm F) of TF [mean; standard deviation (SD); n] found in toothpaste brands A (1,502.3; SD = 45.6; n = 33), B (1,135.5; SD = 52.7; n = 48) and D (936.8; SD = 20.5; N = 8) were close to those stated on the package, 1,500, 1,100 and 1,000 ppm F, respectively. In toothpaste C, we found a mean of 274.1 ppm (SD = 219.7; n = 10) of TF, which diverges from the declared concentration of 1,500 ppm F. In addition, the five tubes of lot no. 11681118 of toothpaste C did not contain fluoride. Regarding TSF, with the exception of toothpaste D (937.9; SD = 40.29), the others had a lower concentration than their respective TF.We found serious problems of quantity and quality of fluoride in toothpaste distributed by the SUS in Manaus, which shows the need for surveillance of these products and confirms the urgency of revising resolution RDC No. 530.

Introdução: A fluoretação das águas de abastecimento público representa uma importante medida de saúde pública para prevenção da cárie dentária, devendo ser monitorada quanto ao teor de fluoreto em dose ideal, bem como em relação ao seu alcance populacional na perspectiva de reduzir as desigualdades e proporcionar benefícios em saúde bucal. Objetivo: O estudo avaliou a equidade na distribuição de água fluoretada na cidade de Manaus/AM, por meio da relação entre indicadores contextuais de desenvolvimento municipal e os teores de fluoreto na água de abastecimento dos bairros que compõem os distritos sanitários da cidade. Método: Realizou-se estudo ecológico transversal no período de 2016 a 2018. Amostras de água foram coletadas mensalmente de cada distrito sanitário, cujas concentrações de fluoreto foram determinadas utilizando-se um eletrodo específico. Índice de Desenvolvimento Humano Municipal (IDHM), mortalidade Infantil,número de crianças fora da escola e expectativa de vida representaram os indicadores contextuais do município, obtidos a partir do Atlas do Desenvolvimento Humano no Brasil. Os dados foram submetidos a uma análise descritiva, estatística bivariada e análise espacial. Resultados: Observou-se grande variação nos teores de fluoreto das amostras, das quais 50,02% apresentaram concentrações de fluoreto inadequadas e as maiores concentrações predominaram nas amostras coletadas no segundo semestre do ano. A distribuição espacial indicou que os bairros com melhores valores de IDHM, mortalidade infantil, número de crianças fora da escola e expectativa de vida apresentaram melhor concentração de fluoreto na água de abastecimento. Conclusões: Evidenciou-se a ausência de equidade na distribuição de água fluoretada, sugerindo que o acesso à água fluoretada reflete as desigualdades sociais presentes na própria cidade.

OBJETIVO: Determinar o potencial anticárie dos dentifrícios distribuídos pelas unidades básicas de saúde (UBS) de Manaus-AM. MÉTODOS: Noventa e nove bisnagas de dentifrícios de quatro marcas comerciais foram coletadas de 7 de outubro de 2019 a 11 de outubro de 2019 em 16 UBS, que foram codificados por marca e UBS de origem. De acordo com a embalagem, os dentifrícios das quatro marcas e seus lotes foram formulados com monofluorfosfato de sódio (Na2FPO3) e a maioria (91%) tinha carbonato de cálcio (CaCO3) como abrasivo. Foram determinadas as concentrações de fluoreto total (FT = FST + Fins) e de fluoreto solúvel total (FST = íons F- ou FPO32-), para certificar se atendiam à Resolução ANVISA RDC Nº530 (máximo de 1.500 ppm de FT) e se tinham potencial anticárie (mínimo de 1.000 ppm de FST). As análises foram feitas com eletrodo íon específico. RESULTADOS: As concentrações (ppm F) de FT [média; desvio padrão (DP); n] encontradas nos dentifrícios A (1.502,3; DP = 45,6; n = 33), B (1.135,5; DP = 52,7; n = 48) e D (936,8; DP = 20,5; n = 8) foram próximas ao descrito na embalagem, 1.500, 1.100 e 1.000 ppm F, respectivamente. No dentifrício C, foi encontrada média de 274,1 ppm (DP = 219,7; n = 10) de FT, divergindo da concentração declarada de 1.500 ppm F. Em acréscimo, as cinco bisnagas do lote no 11681118 do dentifrício C não foram fluoretadas. Quanto ao FST, à exceção do dentifrício D (937,9; DP = 40,29), os demais apresentaram concentração inferior ao seu respectivo FT. CONCLUSÃO: Observou-se problemas graves de quantidade e qualidade do fluoreto nos dentifrícios distribuídos pelo SUS em Manaus, mostrando a necessidade de vigilância desses produtos e ratificando a urgência da revisão da resolução ANVISA RDC Nº 530.

This study aimed to test the association of contextual and individual socioeconomic status with tooth loss among Brazilian elderly people aged 65&ndash, 74 years. Data from 5435 elderly participants from the Brazilian National Oral Health Survey (2010) were linked to city-level data for 27 state capitals and the Federal District. Tooth loss was clinically assessed according to the number of missing natural teeth. Contextual social variables included Human Development Index income (HDI-income) and HDI-education. Individual socioeconomic measures were monthly family income and years of schooling. Covariates included sex, skin colour, number of residents per room and number of goods. Multilevel Negative Binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals between contextual and individual variables and tooth loss. Contextual and individual income and education measures were consistently associated with tooth loss. Elderly people living in cities with low HDI-income and low HDI-education were respectively 21% and 33% more likely to present tooth loss. Cross-level interaction suggested that the relationship of lower income and lower schooling with tooth loss is different across levels of city-level income and city-level education inequality, respectively. Public policies aiming to reduce the income and education gaps and preventive dental interventions are imperative to tackle tooth loss among elderly people.

Objective: To analyze the distribution of Centers of Dental Specialties (CEO) implemented in Brazil until 2014 and identify the contextual and individual variables associated with the geographical accessibility, considering the user's perspective. Material and Methods: The study was conducted with data from the Improving Access and Quality of CEOs (AVE/PMAQ CEO) External Evaluation and contextual characteristics of states and municipalities. The AVE/PMAQ CEO was an evaluative research with cross-sectional observational character, performed in all CEOs in Brazil, with 932 services evaluated and 8,897 users interviewed. Data analysis was conducted in two stages, considering the study dimensions. Analyses were conducted on the availability of units by region, state, population size of the municipality and contextual variables. Then, the relationship between explanatory variables and the user's displacement time and with the intention to change the service location was evaluated using generalized linear regression analysis. Results: The 932 CEOs evaluated were located in 780 of the 5,570 municipalities of the country and the majority was located in the northeastern (38.3%) and southeastern regions (36.2%), with the northern and mid-western regions presenting the lowest absolute number of units. The average displacement time to the CEO was 28.4 minutes, while the intention to change CEO location due to the distance from home was reported by 7.8% of users. Lower geographical accessibility was reported in the northern region and for individuals who reported living in the rural area and in cities with larger populations. Conclusion: The availability of CEOs in the country is still low and not equitably distributed among states and regions.

O objetivo do estudo foi avaliar a prática do planejamento nos Centros de Especialidades Odontológicas (CEO) do estado do Amazonas que fizeram adesão ao Programa Nacional de Melhoria do Acesso e da Qualidade dos Centros de Especialidades Odontológicas (PMAQ/CEO) do 1º Ciclo. Realizou-se um estudo do tipo descritivo e seccional, utilizando-se microdados da avaliação externa do programa, a respeito das avaliações do módulo VIII referente à entrevista com profissionais, direcionado aos gerentes e cirurgiões-dentistas (CD). Os dados foram obtidos e tabulados pelo programa TabWin sendo exportados para o programa Excel. Dos 11 CEO estudados, somente 36,4% possuíam gerentes que atuavam exclusivamente na função e apenas 1 CEO realizou alguma ação de planejamento nos últimos 12 meses. Apesar de grande parte deles relatarem a realização de reuniões das equipes e procederem à autoavaliação, apenas 4 realizaram o monitoramento e análise das metas por especialidade e avaliaram as ações planejadas/programadas. Concluiu-se que a prática do planejamento nos serviços públicos de atenção secundária em saúde bucal no Amazonas ainda é frágil e incipiente para alcançar a melhoria do acesso e da qualidade dos serviços prestados à população.

This study assessed the relationships between socioecononic status (SES), social support, oral health beliefs, psychosocial factors, health-related behaviours and health-related quality of life (HRQoL) in adolescents. A school-based follow-up study involving 376 12-year-old adolescents was conducted in Manaus, Brazil. Baseline data included sociodemographic characteristics (sex, parental schooling, family income, household overcrowding and number of goods), social support (SSA questionnaire), oral health beliefs and psychosocial factors (Sense of Coherence [SOC-13 scale] and self-esteem [Rosenberg Self-Esteem Scale]). Health-related behaviours (toothbrushing frequency, sedentary behaviour, smoking and sugar consumption) and HRQoL [KINDL questionnaire] were assessed at 6-month follow-up. Structural Equation Modelling assessed the relationships between variables. Greater social support (β = 0.30), higher SOC (β = 0.23), higher self-esteem (β = 0.23), higher toothbrushing frequency (β = 0.14) and less smoking (β = − 0.14) were directly linked with better HRQoL. SES (β = 0.05), social support (β = 0.26), oral health beliefs (β = − 0.02) were indirectly linked to HRQoL. Higher SES directly predicted higher toothbrushing frequency (β = 0.14) and less smoking (β = − 0.22). Greater social support also directly predicted higher SOC (β = 0.55), positive oral health beliefs (β = − 0.31) and higher self-esteem (β = 0.58). Greater social support indirectly predicted less smoking via oral health beliefs (β = − 0.05) and less sugar consumption via SOC (β = − 0.07). Socioeconomic status, social support, oral health beliefs and psychosocial factors were important predictors of adolescent’s health behaviours and HRQoL over 6-month period through direct and indirect mechanisms. Health behaviours also directly influenced HRQoL.

O presente trabalho visa relatar a vivência de uma equipe interprofissional na implementação de ações de educação em saúde para promoção da alimentação saudável entre escolares da rede pública de ensino, através do Programa Saúde na Escola (PSE), uma das políticas desenvolvidas pelo Ministério da Saúde (MS). Trata-se de um estudo qualitativo, descritivo, do tipo relato de experiência. As ações foram realizadas entre os meses de julho a agosto de 2019 em uma escola municipal com crianças do 1º ao 5º ano do ensino fundamental I, durante um período de 04 dias, totalizando 22 turmas do turno matutino e vespertino, na cidade de Manaus/AM. Em todo o processo ficou evidente para a equipe a importância da interação interprofissional explícita entre acadêmicos, docentes e profissionais de saúde, o que tornou possível estabelecer práticas colaborativas entre a profissões envolvidas. Foi possível vivenciar um dos lemas da Educação Interprofissional em Saúde (EIP) “aprender juntos para trabalhar juntos através de práticas colaborativas em saúde”.

Objective: To evaluate salivary flow and buffer capacity by means of mechanical and chemical-mechanical stimuli, through the use of chewing gums. Material and Methods: The study was a cross-sectional study with 12 volunteers, divided into three groups, in three phases: Group A: paraffin gum; Group B: Chewing gum without sucrose, flavored (Trident ® ); Group C: Flavored chewing gum, without sucrose and amorphous calcium casein-phosphate phosphopeptide (Trident Total ® ). The stimulated total saliva was collected after 5 minutes of mastication of one of the products and the volume was expressed in mL / min. The same sample was submitted to pH measurement with the use of a digital potentiometer, where the results were classified in normal buffer capacity (final pH between 5.0 and 7.0) or low (final pH

Objective. Evaluate the spatial distribution of health services in primary care according to the characteristics of social vulnerability in the city of Manaus, Amazonas, Brazil.Methods. Selection of the census tracts that compose each human development unit was performed, creating a geographic database. Indicators were selected for each territorial unit and two constructs of social vulnerability were predicted using principal component analysis: one crude and other weighted by the population size. Four maps were created showing quintiles distribution of the constructs, with an overlap of spatial distribution of the coverage area of the family health and oral health teams. The descriptive analyzes of each map were performed.Results. 62.1% of the territories of the existing family health teams and 74.2% of the oral health teams were located in areas of greater social vulnerability, represented by the two worst construct quintiles. However, when considering the resident population, an increase of the teams coverage in areas of lower weighted vulnerability was observed.Conclusion. Despite low coverage the health teams were concentrated on areas of greater social vulnerability. Considering the population distribution of the municipality would allow an even more equitable distribution of health teams regarding organizational accessibility once it is expected that an equitable geographical distribution minimize barriers to access and improve the health conditions and quality of life of the population. The differences in levels of social vulnerability must be considered when making health policies, especially in places where the healthcare territorial coverage is low.

AIM: To examine the evidence on the influence of oral health status on school performance and school attendance in children and adolescents. DESIGN: A systematic review was performed in accordance with PRISMA included epidemiological studies that assessed concomitantly oral health measures, participants' school performance and/or school attendance. Electronic search was conducted on MEDLINE, SCOPUS, Web of Science, ScienceDirect, and LILACS. Studies published up to May 2018 in any language were eligible. The risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis was used to obtain pooled estimates between oral health measures and school performance and school attendance. RESULTS: Eighteen studies were included. Of them, fifteen studies were used for the meta-analyses. Most studies were assessed as moderate quality. Children with one or more decayed teeth had higher probability of poor school performance (OR = 1.44 95%CI: 1.24-1.64) and poor school attendance (OR = 1.57 95%CI: 1.08-2.05) than caries-free children. Poor parent's perception of child's oral health increased the odds of worse school performance (OR = 1.51 95%CI: 1.10-1.92) and poor school attendance (OR = 1.35 95%CI: 1.14-1.57). CONCLUSIONS: Children and adolescents with dental caries and those reporting worse oral health experience poor school performance and poor school attendance.

BACKGROUND: There is little evidence on the association between periodontal disease and oral health-related quality of life (OHRQoL) in individuals with chronic diseases, including hypertension. The aim of this study is to identify relationships among sociodemographic characteristics, smoking, tooth loss, dental caries, periodontal status, and OHRQoL in adults with systemic arterial hypertension.METHODS: A cross-sectional study involving 195 adults (mean age: 55.7 years) with systemic arterial hypertension used interviews and oral examinations to collect data on sociodemographic characteristics (age, sex, income); use of antihypertensive medication; smoking; tooth loss; dental caries; periodontal status (bleeding on probing, calculus, and attachment loss); and OHRQoL/oral health impact profile. The Wilson and Cleary (Wilson IB, Cleary PD. JAMA 1995;273:59-65) conceptual model was used to test direct and indirect relationships among variables using structural equation modeling.RESULTS: Lower age, male sex, smoking, and lower income directly predicted worse periodontal status. Tooth loss, dental caries, worse periodontal status, and smoking were directly linked to poor OHRQoL. Age was indirectly linked to worse periodontal status via income. Income and smoking indirectly predicted poor OHRQoL via periodontal status.CONCLUSIONS: Findings support an effect of periodontal disease on OHRQoL in people with systemic arterial hypertension. Periodontal status mediated associations of sociodemographic characteristics and smoking with OHRQoL through different pathways.

The aim of this study was to describe the patterns of multimorbidities of oral clinical conditions in children. The association between social position and number of oral clinical conditions, and the relationship of social position and number of oral clinical conditions with oral health-related quality of life [OHRQoL, measured using the Brazilian Child-Oral Impacts on Daily Performance (Child-OIDP)] were also investigated. The study analysed data on 7,208 children, 12 yr of age, from the Brazilian Oral Health Survey (SBBrasil Project). Cluster analysis based on the observed/expected (O/E) ratios identified six significant clusters of oral clinical conditions: (i) dental caries and missing teeth; (ii) dental caries and dental trauma; (iii) dental trauma and gingivitis; (iv) dental caries, missing teeth, and dental trauma; (v) dental caries, dental trauma, and gingivitis; and (vi) all oral clinical conditions. Ordinal regression showed that poor social position was associated with a large number of oral clinical conditions. Poisson regression demonstrated that low social position and greater number of oral clinical conditions increased the likelihood of poor OHRQoL (Child-OIDP extent). The four oral clinical conditions clustered into six distinct clusters among Brazilian children. Multimorbidity of oral clinical conditions predicted poor OHRQoL. Social position was of high relevance to multimorbidity of oral clinical conditions and children′s OHRQoL.

There is limited evidence concerning the role of social networks on the oral health of adolescents. This study assessed the association between the participation of adolescents in community groups and dental caries. A cross-sectional household-based study was carried out involving 200 subjects aged 15-19 years living in a deprived area in the state of Amazon, Brazil. Dental caries was assessed through dental examinations using the DMFT index conducted by a single examiner who was previously calibrated. Four dental caries outcomes were investigated, including caries experience (DMFT score), current caries (number of current decayed teeth), missing teeth due to caries, and the care index (ratio between number of filled teeth and DMFT score). Details of participation of adolescents in community groups, demographic and socioeconomic data and information on dental visiting were obtained through individual interviews. All caries measures were significantly higher in adolescents who did not participate in community groups compared to their counterparts. Multivariate Poisson regression showed that participation of adolescents in community groups was independently associated with all dental caries outcomes. After adjusting for confounders, participation in community groups was statistically associated with lower DMFT score (ratio of mean, RM: 0.33, 95% CI: 0.24-0.46), fewer decayed teeth (RM: 0.23, 95% CI: 0.11-0.47), fewer missing teeth (RM: 0.28, 95% CI: 0.17-0.47), and higher care index (RM: 1.69, 95% CI: 1.24-2.29) than those who did not participate. Participation of adolescents in community activities was related to lower levels of dental caries.

INTRODUCTION : In 2011, the Brazilian Ministry of Health rolled out a program for the external quality assessment of rapid human immunodeficiency virus (HIV) tests using the dried tube specimen (DTS) method (EQA-RT/DTS-HIV). Our objective was to evaluate the implementation of this program at 71 voluntary counseling and testing centers (VCTCs) in the Brazilian Legal Amazonian area one year after its introduction. METHODS : Quantitative and qualitative study that analyzed secondary data and interviews with healthcare workers (HCWs) (n=39) and VCTC coordinators (n=32) were performed. The assessment used 18 key indicators to evaluate the three dimensions of the program's logical framework: structure, process, and result. Each indicator was scored from 1-4, and the aggregate results corresponding to the dimensions were expressed as proportions. The results were compared to the perceptions of the HCWs and coordinators regarding the EQA-RT/DTS-HIV program. RESULTS: The aggregate scores for the three dimensions of structure, process, and result were 91.7%, 78.6%, and 95%, respectively. The lowest score in each dimension corresponded to a different indicator: access to Quali-TR online system 39% (structure), registration in Quali-TR online system 38.7% (process), and VCTC completed the full process in the program's first round 63.4% (result). Approximately 36% of the HCWs and 52% of the coordinators reported enhanced trust in the program for its rapid HIV testing performance. CONCLUSIONS: All three program dimensions exhibited satisfactory results (>75%). Nevertheless, the study findings highlight the need to improve certain program components. Additionally, long-term follow-ups is needed to provide a more thorough picture of the process for external quality assessment.

PURPOSE: To evaluate the oral health conditions of pregnant women enrolled in the Prenatal and Birth Humanization Program of the Theomário Pinto Costa primary healthcare unit in the south-central zone of Manaus, Amazonas METHODS: The population comprised 50 pregnant women, independent of pregnancy trimester. To assess the prevalence of dental caries, we used the DMFT Index, and for gingivitis, we used the Plaque Index and Gingival Bleeding Index. A questionnaire was used to investigate socioeconomic conditions, access to dental services and self-perception regarding oral health. RESULTS: One hundred percent of the population presented with caries; the mean DMFT score was 10.0, and the M component (missing teeth) was predominant (4.28). Among the pregnant women examined, 62% presented with moderate gingival inflammation, and 64% presented with at least some plaque. With regard to educational level, 10% of the population had completed an elementary education, 20% had not completed an elementary education, 34% had completed a high school education, and 6% had not completed a university-level education. CONCLUSION: Considering the results, it can be seen that the oral health status of the population was unfavorable, although a majority considered their oral health to be normal or good. OBJETIVO: Avaliar as condições de saúde bucal de gestantes cadastradas no Programa de Humanização no Pré-natal e Nascimento (PHPN) na Unidade Básica de Saúde “Theomário Pinto Costa, situada na zona centro-sul de Manaus-AM”. METODOLOGIA: A população estudada foi composta por 50 gestantes, independente do trimestre de gravidez. Para medir a prevalência de cárie utilizou-se o índice CPO-D e para gengivite foram utilizados Índices de Placa e Sangramento Gengival. Por meio de um questionário estruturado foram investigadas as condições sócio-econômicas, o acesso aos serviços odontológicos e a auto-percepção em saúde bucal. RESULTADOS: A população estudada apresentou 100% de prevalência de cárie com CPO-D médio de 10,0 sendo o componente P (dentes perdidos) predominante na composição do índice (4,28). Das gestantes examinadas, 62% apresentaram inflamação gengival moderada e 64% apresentaram placa mínima. O grau de escolaridade apresentou a seguinte distribuição: 10% ensino fundamental completo; 20% ensino fundamental incompleto; 34% ensino médio completo; 6% ensino superior incompleto. CONCLUSÕES: Diante dos resultados obtidos, pôde-se constatar que as condições de saúde na população de gestantes estudadas foram desfavoráveis; entretanto, a maioria a considerou regular ou boa.

Universidade Federal do Amazonas. Faculdade de Odontologia. Manaus, AM, Brasil. Universidade Federal do Amazonas. Faculdade de Medicina. Manaus, AM, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisa Leônidas & Maria Deane. Manaus, AM, Brasil. Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Departamento de Administração e Planejamento em Saúde. Rio de Janeiro, RJ, Brasil. O objetivo deste artigo é analisar o processo de gestão da atenção básica, aí incluído o Programa de Saúde da Família (PSF), em cinco municípios da Amazônia Ocidental. A descentralização, entendida como meio de aprimoramento da gestão local, também foi investigada. Trata-se de um estudo qualitativo, que explorou o plano político-institucional dos sistemas de saúde dos municípios, através das dimensões projeto de governo, capacidade de governo e governabilidade. A coleta de dados foi realizada por meio de técnicas combinadas: análise da documentação oficial dos sistemas municipais de saúde; realização de entrevistas semiestruturadas junto aos gestores municipais de saúde e gerentes intermediários da atenção básica, do PSF e da direção de unidades de saúde (PSF e não PSF) para subsidiar estudo sobre o modelo de gestão e atenção à saúde, e consulta aos sistemas nacionais e municipais de informação. Os resultados mostraram baixa capacidade gestora, dificuldade em definir prioridades para a saúde, inexistência ou incipiência de ações intersetoriais, limitação na autonomia financeira e uma base de apoio político precária; limitada formação técnica dos gestores e de suas equipes, com carência de aperfeiçoamento profissional; quadro técnico dos profissionais da rede de serviços insuficiente em número e em qualificação para efetuar uma gerência qualificada de serviços de atenção primária à saúde. The objective of this paper was to analyze the primary healthcare management process, including the Programa Saúde da Família (PSF - Family Health Program), in five municipalities located in the western part of the Amazon region. Decentralization, understood as a means of improving the local management, was also investigated. This was a qualitative study that explored the political-institutional level of the municipalities’ healthcare systems through the dimensions of government project, government capacity and governability. Data collection was accomplished by means of combined techniques: analysis of official documentation from the municipal healthcare systems; conduction of semi-structured interviews with municipal healthcare managers, managers of the primary healthcare services, of PSF and of the administration of healthcare units (both PSF and non-PSF) to subsidize a study on the healthcare provision and management model; and consultation of the national and municipal information systems. The results showed low management capacity, difficulty in defining healthcare priorities, nonexistent or incipient intersectoral actions, limited financial autonomy and a precarious political support base; limited technical training of managers and their team; insufficient and low-qualified technical staff of the services network, which prevent them from performing a skilled management of primary healthcare.

In the light of the scarcity of epidemiological studies on the oral health of the general population within the context of the Amazon region, this study aimed to estimate the prevalence of dental caries and gingivitis, as well as to evaluate the need for restorative treatment, among school students aged 15 to 19 years in the city of Manaus, AM, Brazil. A cross-sectional study was carried out on a sample of 889 students from within city limits who were enrolled in 26 public and private schools. Dental examinations were performed to obtain the DMFT index (decayed, missing and filled teeth) as well as to determine the treatments needed. The gingival index (Lõe & Silness) was used to classify gingivitis. The intra-examiner diagnostic concordance was 94% and the Kappa statistic was 0.91. The DMFT index found was 4.65 (± 0.12), without significant difference between the sexes or skin color groups. The prevalence of dental caries was 87.4%. Restoration of a dental surface was the greatest need (59.3%). Slight gingival inflammation was present in 78.5% and gingival bleeding following probing occurred in 53.3%. Although the DMFT index was lower than that observed for the northern region of Brazil, restorative dental services are lacking for this population. Additional studies are suggested to better understand the differences found.

Made available in DSpace on 2017-05-29T18:47:22Z (GMT). No. of bitstreams: 1 S0144.pdf: 632293 bytes, checksum: 44d949058d0a3dc41c9e53f943751775 (MD5) Previous issue date: 2016-07-31 FAPEAM RESUMO O objetivo do presente estudo será de analisar a produção científica sobre a temática Saúde Bucal na APS no período de 2005 a 2014. Será um estudo de revisão sistemática sem meta-análise utilizando a hierarquia da evidência (Figura 1). Inicialmente, será realizada uma busca nas seguintes bases de dados: Centro Latino-americano e do Caribe de Informação em Ciências da Saúde (BIREME), MEDLINE, PubMed, LILACS, BBO e biblioteca virtual SciELO. Os descritores de assunto utilizados para busca será saúde bucal na APS e se limitará a estudos desenvolvidos no Brasil, escritos em inglês, português ou espanhol no período de janeiro de 2005 a dezembro de 2014. Para seleção dos estudos, inicialmente será avaliado título e resumo/abstract, quando os mesmos não forem esclarecedores, o estudo deverá ser buscado na íntegra. Os estudos serão avaliados de forma independente por dois autores. Os estudos que cumprirem os critérios de inclusão serão avaliados quanto à qualidade metodológica baseada na lista de Delphi (VERHAGEN et al, 1998). Os estudos incluídos na revisão sistemática poderão ser apresentados em um quadro com suas características como tipo de estudo realizado, local de realização da pesquisa, autores, ano de publicação, revista de publicação, origem institucional dos autores, uso de programas estatísticos, metodologia utilizada e resultados encontrados.

Made available in DSpace on 2016-09-23T15:35:47Z (GMT). No. of bitstreams: 1 S013.pdf: 489062 bytes, checksum: 9759a6d1f38ea7d9d3b2c215ca9af9c3 (MD5) Previous issue date: 2013-07-31 FAPEAM O objetivo do presente estudo será descrever os CEO implantados nos municípios do Estado do Amazonas e avaliar o cumprimento das metas propostas para cada tipo de CEO. Será um estudo do tipo descritivo, quantitativo, o qual utilizará dados secundários, a partir da série histórica da produção de procedimentos odontológicos (quantidade apresentada) realizados nos CEO do Amazonas registrados pelo SIA/SUS no período de 2005 a 2011. A coleta dos dados será a partir do banco de dados do Departamento de Informática do SUS (DATASUS), informações do SIA/SUS, segundo o Cadastro Nacional de Estabelecimentos de Saúde - CNES dos CEO pesquisados. Como critério de inclusão para o estudo, será os CEO implantados a partir do ano de 2005, e como critério de exclusão, os CEO implantados em 2011 e os CEO sem informação por três anos consecutivos. Os dados serão obtidos e tabulados pelo programa Tab para Windows TABWIN (Ministério da Saúde, Brasil) sendo exportados para o programa Excel, versão 2010 (Microsoft Corp., Estados Unidos), onde será feita consolidação e agrupamento de acordo com os subgrupos de procedimentos odontológicos que deverão ser avaliados: subgrupo de procedimentos de Atenção Básica, subgrupo de procedimentos de Periodontia, subgrupo de procedimentos de endodontia e subgrupo de procedimentos de cirurgia oral menor. Será utilizada a avaliação normativa que consiste na análise da produção média mensal por subgrupo de procedimentos odontológicos em função das metas de desempenho estabelecidas para cada tipo de CEO, segundo Portaria n. 1.464/GM de 2011, em relação ao cumprimento global da meta. Assim, será adotado um indicador denominado Cumprimento Global das Metas que é o resultado da operacionalização do quociente resultante da média mensal de procedimentos realizados de cada subgrupo de especialidades odontológicas pelo número de procedimentos correspondentes à meta deste subgrupo multiplicado por 100. Os CEO que cumprirem percentuais ≥ a 100% do que é normatizado para cada subgrupo será enquadrado como meta atingida, recebendo para tanto uma classificação de desempenho, a saber: ruim (CEO que cumpriram 1 meta), regular (CEO que cumpriram 2 metas); bom (CEO que cumpriram 3 metas) e ótimo (CEO que cumpriram todas as metas). Para a descrição dos CEO será verificado variáveis como tipo de CEO (1, 2 ou 3), data de implantação, tempo de funcionamento e produção ambulatorial. Os municípios participantes da pesquisa serão caracterizados por porte populacional, cobertura populacional das Equipes de Saúde Bucal ESB na Estratégia Saúde da Família e Índice de Desenvolvimento Humano Municipal IDH-M.

Made available in DSpace on 2016-09-23T15:35:47Z (GMT). No. of bitstreams: 1 S012.pdf: 548845 bytes, checksum: defe4ebcc63047ad45bc8b99f46a5d48 (MD5) Previous issue date: 2013-07-31 CNPQ Com o objetivo de descrever a evolução das ESB na Estratégia Saúde da Família nos municípios amazonenses será adotado um estudo descritivo com enfoque retrospectivo. O universo do estudo será composto pelos 62 municípios do Estado do Amazonas. As informações referentes aos números de municípios com ESB implantadas e de ESB, ano de habilitação das ESB, bem como a cobertura populacional serão obtidas a partir do Cadastro Nacional de Estabelecimento de Saúde - CNES e DATASUS. Para descrever as características do objetivo proposto será utilizado o espaço territorial do Estado do Amazonas segundo a Constituição Estadual que congrega os 62 municípios integrados em nove sub - regiões e um centro regional Manaus. O período de abrangência do estudo será desde 2001, ano em que foi instituído pelo Ministério da Saúde incentivo financeiro para o município que incorporasse ESB na Estratégia Saúde da Família, até 2011. Serão incluídos no estudo os municípios que possuam ESB em atividade e serão excluídos os municípios que não possuam ESB implantadas, que tiverem ESB descredenciadas em sua totalidade, sem informação por um período de três anos seguidos e que tenham menos de um ano de implantação. A análise estatística operacionalizada será descritiva com apresentação de proporções e percentagens.

Made available in DSpace on 2016-09-23T15:09:09Z (GMT). No. of bitstreams: 1 RELATORIO_FINAl_S_0025-2009.pdf: 968494 bytes, checksum: 7a65a8f0089ce860606ffd6d495bfe96 (MD5) Previous issue date: 2010-07-29 CNPQ O consumo de bebidas ácidas pode ser considerado como um dos fatores etiológicos extrínsecos do desgaste dental, que se caracteriza por um tipo de lesão predominantemente cervical, não cariosa e que se desenvolve como conseqüência da perda gradual de estrutura dental causada por ação química (ácidos e/ou quelantes), sem o envolvimento de bactérias. A ação química pode ser resultante de fatores intrínsecos, tais como ácido gástrico devido ao refluxo, vômito e bulimia (Milosevic & Slade, 1989; Scheutzel, 1996); ou extrínsecos, como ácidos ambientais provenientes do cigarro e da indústria, piscinas cloradas e bebidas ácidas, como sucos cítricos e refrigerantes (Nunn, 1996; Zero, 1996). Considerando a carência de estudos de bebidas ácidas da região amazônica e sua relação com a erosão, o objetivo do presente estudo é analisar o pH, a capacidade tampão, o conteúdo mineral de Ca e Pi de produtos naturais do Amazonas e, em um modelo in vitro, avaliar a capacidade erosiva dos mesmos. Os produtos serão: suco de cupuaçú, suco de camu-camu, guaraná em pó ( diluído), tucupi ( uma iguaria líquida muito utilizada na culinária regional). Os produtos serão adquiridos no Mercado Municipal de Manaus. Como controles serão utilizados água e Coca-Cola®. Para o modelo in vitro, serão utilizados blocos de esmalte bovino, armazenados em formol 2% e pH 7,0, a partir dos quais serão preparados blocos de esmalte, adequados para determinação de microdureza superficial. Para a análise inicial da microdureza, a superfície do bloco de esmalte será medida com a utilização de um microdurômetro (Shimadzu HMV-2000), com um diamante Knoop, com carga de 50g por 5 segundos. Então, os blocos dentais serão submetidos a ciclagens erosivas e remineralizantes in vitro: imersão nos respectivos grupos de tratamento (25 ml/bloco) por 10 minutos 4 vezes ao dia por 15 dias; entre as exposições e durante à noite, os blocos dentais serão armazenados em solução remineralizante a 37ºC. A dureza de superfície dos blocos dentais será então novamente mensurada para obter-se a perda de dureza de superfície (%PDS). A análise mineral de Ca também será repetida nas bebidas após cada tempo de imersão dos blocos e o valor encontrado será subtraído da concentração inicial de Ca nos sucos, sendo utilizada como indicador químico da erosão. As variáveis de resposta serão submetidas a uma análise estatística exploratória, a partir da qual será aplicado um teste apropriado, ao nível de 5% de significância. Os dados obtidos para as variáveis de resposta das análises dos produtos (pH, capacidade tampão e concentração de Ca e Pi) serão comparados entre os diferentes substratos com os controles negativo e positivo. Para as variáveis de resposta do ensaio in vitro, os dados serão também comparados entre os diferentes substratos com os controles negativo e positivo.