Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / O conhecimento sobre as condiÃÃes de saÃde bucal e sobre a utilizaÃÃo de serviÃos odontolÃgicos por pessoas que vivem com HIV/Aids (PVHA) constitui fator importante para planejar aÃÃes com o intuito de disponibilizar uma atenÃÃo odontolÃgica de qualidade à essa populaÃÃo. O presente estudo teve como objetivo principal identificar os fatores relacionados à utilizaÃÃo de serviÃos odontolÃgicos e condiÃÃes de saÃde bucal das PVHA no municÃpio de Fortaleza â CearÃ. Para tal, foi realizado um estudo transversal com abordagem quantitativa, desenvolvido de agosto a dezembro de 2009, com PVHA que faziam acompanhamento nos ambulatÃrios de infectologia do Hospital UniversitÃrio Walter CantÃdio (HUWC) e do Centro de Especialidades MÃdicas Josà de Alencar (CEMJA). Foram coletados dados sobre o estado clÃnico-laboratorial dessas pessoas, sobre condiÃÃes sociodemogrÃficas, utilizaÃÃo de serviÃos odontolÃgicos e sobre as condiÃÃes de saÃde bucal desta populaÃÃo. Participaram deste estudo 173 pacientes, sendo 72,3% do sexo masculino e 27,7% do sexo feminino, tendo como idade mÃdia de 36,4 anos. Destes, 50,9% (88/173) afirmaram ainda nÃo ter se consultado com um dentista apÃs infecÃÃo pelo HIV e que 52,6% (91/173) dos participantes afirmaram nÃo revelar ao dentista sua condiÃÃo sorolÃgica diante de um tratamento odontolÃgico. O estudo evidenciou ainda que procurar por atendimento odontolÃgico em serviÃos pÃblicos (RP: 2,39; IC95%: 1,23 â 4,16; p<0,001) e revelar a condiÃÃo sorolÃgica para o dentista (RP: 2,11; IC95%: 1,03 â 4,31; p<0,001) apresentaram associaÃÃo estatisticamente significativa com ter dificuldade de acesso a esses serviÃos. Observou-se alta prevalÃncia de cÃrie (61,3%), de doenÃa periodontal (87,3%) e de alteraÃÃes em mucosa bucal (12,7%) na populaÃÃo estudada. Evidenciou-se que nÃo existe associaÃÃo estatisticamente significativa entre presenÃa de cÃrie e condiÃÃes imunolÃgicas dos pacientes soropositivos (p>0,05). Entretanto, a presenÃa de alteraÃÃes em mucosa bucal apresentou associaÃÃo estatisticamente significativa com baixa contagem de linfÃcitos T CD4 (RP: 4,20; IC95%: 1,74 â 10,13; p<0,001) e elevados nÃveis de carga viral plasmÃtica (RP: 4,74; IC95%: 2,11 â 10,67; p<0,001). Este estudo permitiu concluir que existe na populaÃÃo investigada uma alta prevalÃncia de doenÃas bucais, apresentando, consequentemente, grande necessidade de tratamento odontolÃgico. Entretanto, observou-se tambÃm que existem limitaÃÃes do acesso dessas pessoas aos serviÃos de saÃde bucal. / Knowledge about the oral health status and the use of dental services for people living with HIV / AIDS (PLWHA) is a factor important to plan actions in order to provide a focus Quality dental care to this population. This study aimed to identify the main factors related to utilization of dental services and oral health status of PLWHA in Fortaleza - CearÃ. To this end, A transversal study with a quantitative approach, developed August to December 2009 with PLWHA who were accompanying us infectious disease clinics of a university hospital (HUWC) and Medical Specialties Center Josà de Alencar (CEMJA). We collected Data on the clinical and laboratory such persons, on conditions sociodemographic, utilization of dental services and the conditions of oral health of this population. The study included 173 patients; 72.3% male and 27.7% female, with a mean age of 36.4 years. Of these, 50.9% (88/173) said they had not yet consulted with a dentist after HIV infection and 52.6% (91/173) of participants said not disclose their HIV status to the dentist before a treatment dentistry. The study also showed that searching for dental care public services (PR: 2.39, 95% CI 1.23 to 4.16, p <0.001) and reveal the condition serology for the dentist (PR: 2.11, 95% CI: 1.03 - 4.31, p <0.001) were significantly associated with having difficulty in accessing these services. There was a high prevalence (61.3%), periodontal disease (87.3%) and changes in oral mucosa (12.7%) in this population. It was evident that there is no statistically significant association between caries and immunological conditions of seropositive patients (p> 0.05). However, the presence of changes in oral mucosa was associated statistically significant with low CD4 count (PR: 4.20; 95% CI: 1.74 to 10.13, p <0.001) and high levels of plasma viral load (PR: 4.74; 95% CI: 2.11 to 10.67, p <0.001). This study concluded that there is at investigated population a high prevalence of oral diseases, showing therefore, great need for dental treatment. However, also observed that there are limitations on access to these people oral health services.

Philosophiae Doctor - PhD / Background: Standardized and evidence-based resource allocation frameworks for timely provision of primary dental services may support equitable distribution of comprehensive dental care. However, such frameworks, which can be applicable to primary care settings in Brazil, are not available. The purpose of this study was to explore the complex issue of equity allocation of dental staff for primary dental care services, by estimating time to dental disease progression in order to analyze costs when survival targets are set for patients waiting for primary dental care. The inclusion of wait time benchmarks for dental services in the design of the framework was an attempt to increase knowledge on the quality of access experienced by people living within catchment areas of the Family Health Strategy in Brazil. In view of ever scarce resources for public health services, ethical dilemmas arise in resource allocation when allocation choices require priority setting among individuals who face similar health needs. Since equity of access must be assured for all Brazilian citizens, the present study proposed a rational resource allocation model to help decision-makers in reconciling equity access and budgets. Aim: This study aimed to compare equity of access to dental services and costs of dental staff of two models for primary care settings. Additionally, staffing requirements and staff costs were projected over a three-year time period. Both models comprised three inter-related components: (i) universal access to oral health care, (ii) comprehensiveness of primary dental care and (iii) equity of access to primary dental services. Method: The present study was part empirical and part modeling in design. In the empirical phase, a set of maximum wait times for dental care determined by experts (Model 1) vs. wait times derived from survival analysis (Model 2) was compared. A one-year follow-up of a cohort of dental patients assigned to five primary health care clinics was conducted. The event of interest was clinical deterioration in the waiting time for dental visits. At each consultation with a dentist either for routine or emergency reasons, the oral quadrants of the patient were assessed and classified according to their urgency for dental care (from 1, less urgent to 5, more urgent). In the modeling phase, costs of dental staff were estimated on the basis of survival probabilities found in Model 1 and on survival targets simulated in Model 2. The amount of staff required as calculated by combining data on: dental service needs, activity standards for dental services, workload components in dental care, cost per working hour of dental staff, and probabilities of clinical deterioration in the wait for dental visits. Main Findings: In Model 1 (wait times determined by experts), survival probabilities were found to be unevenly distributed between diagnostic categories: category 4= 0.939 (SE 0.019); category 3= 0.829 (SE 0.035); category 2= 0.351 (SE 0.061) and category 1= 0.120 (SE 0.044). The cost of dental staff in Model 1 was estimated to be R$104 110.88 (BRL). In cost simulations of Model 2, where wait times were derived from the survival analysis study, a similar 0.900 survival probability target for all sampled quadrants (n=7 376) was found regardless of their final classification in the study year. The resulting cost of Model 2 was R$99 305.89 (BRL). Conclusions: From an equity-access perspective, the survival analysis concluded that wait times for dental visits determined by the experts may engender inequitable survival probabilities for oral quadrants classified in different diagnostic categories. From a dental-staff costs perspective, one concluded that less resources were required by setting an equitable 90% survival target for all oral quadrants studied.

Problems concerning the planning and practicing of health care currently exist. Countries are spending more funds on medical care without making a discernible dent in the health status of their citizens. This lack of success in obtaining health is obviously a problem for everyone experiencing ill health or the effects thereof It also creates a personal problem for all health workers, because a halt is being called to profligate spending on health that will affect all. The problems underlying tl:e health care crisis are rising costs, unequal distribution, low productivity, poor heali..ii status, and a lack in sensitivity towards the communities it serves. The multi-disciplinary, complex nature of these problems in health care, their magnitude and their inter-relatedness indicate that traditional approaches to health care planning and management have been inadequate or have failed. An alternative approach to solve these problems is to adopt a holistic view, i.e., to see all parts (components) which contribute to the problem as parts of the whole. By viewing the problem as a whole, more enduring solutions may be formulated. The aim of this study was to employ and evaluate the adoption of a systems approach to solve "real life" problems. The Soft Systems Methodology of Peter Checkland was utilized to assess the situation within the Oral Health Service of the SAMS and to identify relevant systems to improve the situation. The need for a Preventive System and a Performance Measurement System was established. These two systems were planned, developed and implemented using and obeying systems rules and techniques. Both these systems were evaluated and found to be highly efficient, effective, cost-effective and made a positive net contribution to the Oral Health Service of the SAMS. It is finally concluded that the adoption of a systems approach to identify and solve "real life" problems was effective and efficient. It is therefore recommended that a systems approach to the management of oral health, and probably health too, should be embraced by the encumbered health industry. / Dissertation (MChD)--University of Pretoria, 1993. / gm2013 / Community Dentistry / unrestricted

Magister Chirurgiae Dentium (MChD) / An analysis of the oral health related quality of life (OHRQoL) of patients with orofacial clefts at the Wentworth Foundation in Durban, KZN is presented. Objectives: To assess whether the OHRQoL of orofacial cleft patients varies amongst different age groups, genders or cleft types as well as demographic factors. Method: 46 participants, aged 8- 18, completed a self-administered Child Oral Health Impact Profile (COHIP) questionnaire. Results: The most prevalent cleft type was the Unilateral Cleft Left, 45.7%. The COHIP mean score was 84.195 (SD 18.244) ranging from 35 to 110. The age related subscales which were statistically significant included Functional well-being (p value: 0.0456), School Environment (p value: 0.0145) and Treatment Expectancy. The subscale School Environment was statistically significant for: Transport (p value: 0.0267) and Place of accommodation (p value 0.028). The Oral Health subscale and the Educational level were statistically significant (p value 0.043). Conclusion: Statistically significant age-related differences and demographic factors were noted. The OHRQoL of cleft patients was low largely due to socioeconomic factors and difficulty accessing multidisciplinary care. Therefore, our findings highlight the importance of establishing a Cleft lip and palate multidisciplinary facility for these patients in the Wentworth foundation and subsidised transport to the Wentworth Foundation is recommended.

Background: Oral health disparities exist in the USA. However, little is known of the relationship between oral health disparity and citizenship. The aims of this study were: (i) to describe the differences in self-rated oral health (SROH) between adult American citizens and non-citizens (>20 years of age); and (ii) to test whether factors such as frequency of dentist visits and socio-economic status (SES) are differently associated with SROH in these two groups. Methods: The data used in this study were drawn from the National Health and Nutrition Examination Survey conducted in 2011–2012. Weighted logistic regression models were used to detect the strengths of the association between a series of predictors and SROH. Results: More non-citizens (59.54%) than their citizen peers (26.24%) rated their oral health as fair/bad. All factors analysed in this study were differently associated with SROH based on citizenship. More specifically, natural characteristics, such as ethnicity and age, were significantly associated with SROH among non-citizens, and SES was significantly associated with American citizens. Among non-citizens, Hispanic, Non-Hispanic Black and Asian subjects were more likely than Non-Hispanic White subjects to report their oral health as being ‘good’. Family poverty level, education and the frequency of dentist visits were significantly associated with SROH among citizens. Conclusion: The findings of this study indicate that American immigrants report their oral health across most dimensions as being worse than do American citizens. Each explanatory factor may have a different strength of association with SROH in immigrants and citizens, which implies that different steps should be taken within these groups to reduce disparities in oral health.

Objectives: A community-based intervention is described that targets oral health self-care practices among Hispanic children in the United States and is being tested in an ongoing trial. Descriptive results of baseline oral health variables are presented. Methods: As of January 2013, 284 Hispanic children of ages 5-7 enrolled in the Healthy Families Study in Nashville, TN, USA. Families are randomized to one of two culturally appropriate interventions. Results: At baseline, 69.6 % of children brushed at least twice daily, and 40.6 % brushed before bed daily. One-third of parents did not know if their children's toothpaste contained fluoride. Conclusions: This intervention fills the need for community-based interventions to improve oral health self-care practices that are culturally appropriate in Hispanic families.

Maintaining dental health is vital as it contributes to the psychological well-being of an individual and the overall systemic health through preventing chronic diseases. Unfortunately, poor oral health has been identified as a common trend in individuals with Autism Spectrum Disorder (ASD). There is limited research regarding the barriers that result in rates of increased dental manifestations in patients with ASD compared to neurotypical individuals. This study strived to identify the barriers that contribute to poor oral health in individuals with ASD in order to establish interventions to break those barriers and improve overall dental health in the Autism community. A descriptive, mixed methods study design was utilized that included 10 participants: adults with ASD (n=4), parents of children with ASD (n=4) and dental professionals (n=2). The ASD population were asked to complete a questionnaire that asked about home/office dental care, dental issues and anxiety, sensitivity to external stimuli in a dental office, physical challenges and parafunctional habits. Semi-structured interviews were conducted with dental professionals regarding their experience and training in treating patients on the Autism Spectrum. Three of the four parents reported that their child had high levels of anxiety regarding dental visits. Only one adult with ASD reported flossing on a regular basis, and bruxism was reported by all adults with ASD and all but one parent as an area of concern. Interviews with the two dentists revealed that families of individuals with ASD face financial barriers and reported infrequent visits from adults with ASD. Additionally, both dentists received minimal training in working with special populations. Further research is needed to improve the frequency of dental visits in adults with ASD, which can lead to an overall increased quality of life. Additionally, more training and guidance should be provided to dental offices on working with patients with ASD.

The burden of dental disease in American has been termed a "silent epidemic," affecting the most vulnerable populations in society. Poor oral health has been linked with general health issues, such as diabetes and cardiovascular disease, as well as decreased mental health and impairments in social functioning. This burden weighs particularly heavy on the homeless, who are not only denied access to private systems of care, but are further rejected by an inadequately supported public safety net. Despite the recognition of social inequalities and the call for further scientific research, oral health care has not been extensively recognized within sociology. The aim of this research was to uncover how Central Florida's homeless adults cope with oral health issues in the face of barriers. This study intends to begin closing the gap by exploring the ways in which structural inequalities are embodied in the teeth of the homeless. Twenty-five semi-structured interviews were conducted with homeless individuals in the Central Florida area in regards to their oral health and coping mechanisms. Results indicate that without conventional access to dental care, homeless are forced to rely on emergency departments, alcohol, illegal drugs, home remedies, and over-the-counter medications. When treatment was received, only emergency services were provided. This led to an extraction-denture treatment model which left many homeless individuals edentulous, with continued complications in their ability to eat, work, and talk.

Oral health plays an integral role in our general health, wellbeing, and quality of life. Practicing evidence-based oral hygiene behaviors prevent oral diseases and improve systemic health. The burden of preventable oral diseases persists worldwide and weighs particularly heavy on specific population groups. While many studies have explored oral health among those of advanced age, children, and minority groups, there are a very few exploring the oral health care needs of postsecondary students, specifically those born outside of the United States (U.S.). Recognizing this gap in the literature, this study sought to gain a better understanding of oral health access among non-US born postsecondary students with a goal of identifying factors affecting their oral health behaviors. To achieve the objectives of this explorative study, a cross-sectional study design was implemented. A 30-question survey was provided to individuals born outside the U.S. and currently enrolled in postsecondary educational institutions. Descriptive statistics was presented, and a quantitative analysis was performed. The study results suggest that foreign-born postsecondary students may perceive oral health care in the U.S as inaccessible due to economic barriers such as costs and lack of insurance. Moreover, it was found that this population is less likely to visit a dentist because they cannot find a "convenient time" or because they believed their "mouth is healthy". Factors associated with perceived improvements in oral hygiene behaviors included enrollment in postsecondary education and the number of years they've resided in the U.S. Conversely, factors associated with a decline in perceived oral hygiene behaviors included school-induced stress and acculturative stress. It was also found that on-campus dental clinics were less frequently utilized than off-campus dental clinics, with many preferring to receive oral health care outside of the U.S. Citizenship status was also found to be a factor influencing student's oral health seeking behaviors.

No description available.