The elderly population is growing at unprecedented rates worldwide. The increased mortality and decline in fertility have greatly contributed to this and caused the ratio of elderly to the remaining populations in countries around the world to dramatically increase. Furthermore, these numbers show no signs of slowing and are expected to increase at quicker rates. With this, follows the need for better health care systems in order to maintain a good quality of life for this demographic. Of specific interest to this thesis are prevalent oral health conditions in the elderly. Conditions such as xerostomia, dental caries, and periodontal disease plague the elderly population. The research shows how much more prevalent and severe these oral health conditions are in the elderly population and aims to examine these along with effective means of treatment and care. Future measures should be taken to effectively stabilize oral health care for the elderly. Better pubic health care systems need to be put in place that address the access to care issue that exists within the elderly population, along with better promotion of preventative measures.

To improve on the traditional approaches of dental treatment need estimation, a new theoretical model of treatment needs composed of 'Normative', 'Impact-Related', 'Effective' and 'Accessible' treatment needs, is proposed. The aim of the present study was to develop an appropriate socio-dental indicator to generate 'Impact-Related Treatment Need', compare them with traditional professionally assessed normative need, and to explore the preliminary approach to assess 'Effective Treatment Need' for periodontal treatment. An oral health survey was carried out in Ban Phang district, Khon Kaen, Thailand. 501 people aged 35-44 years in 16 villages, selected by cluster random sampling process, were interviewed about oral impacts on daily performances and their oral health behaviours, and then were had clinical examinations. A concise indicator 'Oral Impacts on Daily Performances' (OIDP) was developed, based on measuring impacts on eight physical, psychological and social aspects of daily activities. Scores were calculated by multiplying the frequency by the severity scores of each performance, then scores were summated. The indicator was tested for psychometric properties on the study sample, using interviews and clinical examinations. Cronbach alpha of internal consistency was 0.65. Kappa of test-retest reliability ranged from 0.6 to 1.0. Criterion validity was shown by a strong relationship with general perceptions of oral impacts (p < 0.001). Construct validity was demonstrated by significant differences of scores between groups with high and low prevalence of deep periodontal pockets, decayed and missing teeth, and number of functional teeth (p < 0.001). The combination of specific OIDP scores and normative needs generated the impact-related need for various dental treatments. As expected, the percentage of people with need was decreased from normative need, when Impact-Related Treatment Need was applied. The differences were large in needs for prostheses, orthodontics and periodontal treatment (ranging from 21.7% to 40.2% of normative need); moderate for restorations (64%); and low for pulp care, extractions and treatment for deep periodontal pockets (81.7%-91.7%). A similar pattern of need reduction was obtained when increasing cut-off points of OIDP scores. An exploratory study to develop 'Effective Treatment Need' for periodontal treatment was done. It was shown, using logistic regression that plaque control and smoking were the behaviour-oriented risk factors which affected behavioural propensity for periodontal destruction. Receiver Operating Curve showed the appropriate cut-off point of plaque level at 0.8. Behavioural propensity was determined from people who are non-smokers with plaque index of 0.8 or lower, to generate Effective Treatment Need. The results indicated that the majority of people who had Impact-Related Treatment Need for periodontal treatment did not have the acceptable level of behavioural propensity required for effectiveness of treatment. The advantages of the socio-dental needs approach in dental care planning were demonstrated and discussed. It was concluded that the OIDP is a valid and reliable indicator of oral outcomes. Integrating it into Impact-Related Treatment Need, as well as further integration of behavioural propensity to generate Effective Treatment Need could provide alternative improved dental treatment need estimations.

Orientador: Suzely Adas Saliba Moimaz / Banca: Paulo Zárate Pereira / Banca: Symone Cristina Teixeira / Banca: Wilton Wilney Nascimento Padilha / Banca: Glauco Issamu Miyahara / Resumo: A opinião do usuário na avaliação da qualidade dos serviços de saúde constitui-se em uma importante ferramenta na gestão pública. Nesta pesquisa, objetivou-se analisar a satisfação dos usuários com o serviço odontológico no Sistema Único de Saúde e a autopercepção da saúde bucal. Trata-se de um estudo transversal, tipo inquérito, parte de um projeto multicêntrico realizado em três municípios do Brasil. A coleta de dados foi no município de Aquidauana, MS, no ano de 2013, considerando-se para o cálculo da amostra o total da população adulta na região estudada, com prevalência de 50% de satisfeitos com os serviços prestados. Foram entrevistados 390 usuários, em tratamento odontológico na atenção básica da rede pública, empregando-se um formulário adaptado dos instrumentos do Ministério da Saúde, propostos para o Programa Nacional de Avaliação de Serviços de Saúde (PNASS) e pelo Programa de Melhoria do Acesso e Qualidade (PMAQ). Como critério de exclusão, foram considerados usuários que iriam realizar a primeira consulta, os que apresentassem alguma impossibilidade de responder ao instrumento utilizado e os menores de 18 anos. Do total de entrevistados, 73% eram mulheres; 47,2% tinham de 20 a 39 anos; 56,4% estavam em tratamento odontológico; 26,9% procuraram por motivo de dor; 24% já tinham sido referenciados para o serviço odontológico especializado e a maioria dos encaminhados conseguiu agendar o tratamento. Quanto à satisfação com o serviço oferecido, em relação ao acesso, 97,7% estavam satisfeitos com a forma com que foram recebidos na Unidade; 75,1% disseram que não houve demora na marcação da primeira consulta; 94,1% estavam satisfeitos com o tempo de agendamento; 79% afirmaram que a consulta foi marcada por ordem de chegada; 77,2% consideraram próxima... / Abstract: The user's opinion in assessing the quality of health services is an important tool in public management. The aim of this study was to analyze the users' satisfaction with dental services in the Public Health System and self-perception of oral health status. This is a survey-type cross-sectional study, part of a multicenter study conducted in three municipalities in Brazil. Data collection was in the city of Aquidauana, MS, in 2013, given to the calculation of the total sample of the adult population in the study area, with a prevalence of 50% satisfied with the services provided. We interviewed 390 users in dental treatment in primary care from the public network, using an adapted form of the instruments of the Ministry of Health, proposed for the National Program of Health Services Evaluation (PNASS) and Access Improvement Programme and quality (PMAQ). The exclusion criteria were considered users who would hold the first consultation, to submit any failure to respond to the instrument, and children under 18 years.From the total respondents, 73% were women; 47.2% aged 20-39 years; 56.4% were in dental treatment; 26.9% sought pain of reason. As to the satisfaction of the service provided in relation to access, 97.7% were satisfied with the way they were received in the health unity; 75.1% said that there was no delay in appointing the first visit; 94.1% were satisfied with the scheduling time; 79% said that consultation was marked by order of arrival; 77.2% considered that the distance from home to the office was short; 24% were referred to specialized service and of these, 88% were scheduled, and 66.7% were satisfied to have scheduled in the specialized service. Regarding humanization, 55.6% said that the care given by the oral health team was very good; 96.4% were satisfied with the service provided; whereas 96.9% considered... / Doutor

Orientador: Ângela Cristina Cilense Zuanon / Coorientador: Belinda Nicolau / Banca: Samuel Jorge Moysés / Banca: Aylton Valsecki Junior / Resumo: Doenças bucais são prevalentes em pessoas que vivem na pobreza. Esse fenômeno complexo pode ser explicado por diversos fatores, sendo as barreiras no acesso aos serviços de saúde bucal uma das princípais causas. Além da falta de recursos, pessoas pobres também subutilizam os serviços odontológicos devido às experiências negativas na clínica odontológica. Uma possível razão é que a conceituação, percepção e atitude dos profissionais em relação a pobreza geram impactos diretos sobre a qualidade do cuidado em saúde bucal bem como na relação com os pacientes desfavorecidos. Entendendo que os estudantes serão os futuros profissionais, o objetivo desse estudo foi desvelar a percepção e as atitudes de estudantes de Odontologia sobre a pobreza e as pessoas pobres. Para isso foi realizada uma survey descritiva com os alunos regularmente matriculados no curso de graduação em Odontologia de Universidades Públicas do Estado de São Paulo. Um questionário semi-estruturado foi respondido pelos alunos que aceitaram participar da pesquisa a fim de identificar: 1) os dados gerais dos estudantes; 2) a prática profissional futura pretendida por eles; 3) a percepção e as atitudes dos mesmos com relação a pobreza e as pessoas pobres; 4) e dados sócio-econômicos. Análise descritiva dos dados, cross-tabs e regressão logística com intervalo de confiança de 95% (IC) foram usadas para avaliar a diferença entre os grupos. A análise estatística foi complemetada pela análise fatorial. Foi demonstrado que a prática profissional intencionada pelos estudantes de Odontologia é a de se tornar especialista. Associações foram observadas entre gênero, nível sócio-econômico, universidade e ano de graduação e a intenção de seguir a carreira no serviço público de saúde. O senso de responsabilidade profissional para prestar... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Oral diseases are prevalent amongst people living in poverty. This complex phenomenon can be explained by several factors. The barriers preventing access to oral health services is a major cause. Poor people underutilize dental services due to negative experiences in clinical dentistry. One possible reason is that the conception, perception and attitude of professionals towards poverty generate direct impacts on the quality of care in oral health as well as in relation to disadvantaged patients. Understanding that students are future professionals, the aim of this study was to examine the perceptions and attitudes of dental students about poverty and poor people. A cross sectional study was carried out with students enrolled in the undergraduate program in dental public universities in the state of São Paulo. A semi-structured questionnaire was answered by the students who agreed to participate in the research to identify: 1) the profile of the students, 2) the desired future practice for them, 3) the perception and attitudes of dental students towards poverty and poor people, 4) and socioeconomic data. Descriptive analysis, cross-tabs and logistic regression with confidence interval 95% (CI) were used to evaluate the differences between the groups. Statistical analysis was supplemented by factor analysis. Our study has shown that the practice intended by the dental students is to become a specialist. Associations were observed between gender, socioeconomic status, university and graduation year and students' intentions to pursue a career in public health service. The sense of professional responsibility to provide care for disadvantaged populations as well as the perceptions and attitudes of dental students about the poor were considered moderately positive. We observed a tendency among students... (Complete abstract click electronic access below) / Mestre

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / As cirurgias de transplante de ÃrgÃos sÃlidos foram um dos principais avanÃos da medicina no Ãltimo sÃculo, tornando-se viÃveis apenas com o advento das drogas imunossupressoras, que possuem a capacidade de inibir a resposta do receptor contra o enxerto. Juntamente à evoluÃÃo dos fÃrmacos imunossupressores e das tÃcnicas cirÃrgicas, os riscos pÃs-operatÃrios passaram a ser mais conhecidos, sendo a infecÃÃo, principalmente a bacteriana, um dos principais motivos do insucesso do transplante. Dessa maneira, microorganismos orais tornam-se uma ameaÃa em potencial, embora estes nÃo sejam comumente citados como promotores de infecÃÃes pÃs-transplante na literatura. Dessa forma, à fundamental que o cirurgiÃo-dentista esteja ciente das principais alteraÃÃes orais encontradas nestes pacientes, e que conheÃa suas necessidades de tratamento, a fim de adotar condutas visando à remoÃÃo dos focos infecciosos e eliminaÃÃo do risco pÃs-operatÃrio. O objetivo deste trabalho foi descrever as condiÃÃes de saÃde oral e necessidade de tratamento odontolÃgico de um grupo de pacientes prÃ-transplante de ÃrgÃos sÃlidos. Foi realizado um estudo transversal observacional, mediante de coleta de dados e por exame intra-oral feito por um examinador calibrado. Foram examinados 113 pacientes, sendo 71 (62,83%) indicados para transplante renal, 37 (32,74%) para o hepÃtico e 05 (4,43%) para o cardÃaco. A mÃdia de idade foi de 42,13 anos e a comorbidade mais prevalente foi a hipertensÃo. O Ãndice CPOD mÃdio da amostra foi de 17,27 e o Ãndice Periodontal ComunitÃrio (CPI) mais prevalente durante o exame foi o 02, encontrado em 56 (49,6%) pacientes, indicando alta prevalÃncia de sangramento à sondagem gengival e presenÃa de cÃlculo. A maioria dos pacientes do estudo (81,32%) nÃo mostrou lesÃes de tecidos moles. Avaliando os exames radiogrÃficos, 56 (49,5%) dos indivÃduos apresentavam reabsorÃÃo Ãssea alveolar horizontal e 05 (4,43%) pacientes possuÃam terceiros molares parcialmente erupcionados. Quanto à necessidade de tratamento odontolÃgico, terapia periodontal era indicada em 81,5% dos pacientes, 69,9% possuÃam indicaÃÃo restauradora, 48,6% necessitavam realizar procedimentos cirÃrgicos e 9,7% com indicaÃÃo para tratamento endodÃntico. NÃo houve diferenÃa estatÃstica das variÃveis analisadas entre as trÃs indicaÃÃes de transplantes. Este estudo permitiu concluir que os pacientes examinados possuÃam alta prevalÃncia de doenÃas orais, como cÃrie e gengivite/periodontite, e, consequentemente, grande necessidade de tratamento odontolÃgico. Criteriosa avaliaÃÃo clÃnica deve ser realizada para submeter tais pacientes a procedimentos cruentos, minimizando os riscos hemorrÃgicos. AlÃm disso, hà a necessidade do enfoque à saÃde oral dentro dos serviÃos mÃdicos em pacientes portadores de graus diferentes de insuficiÃncia renal, hepÃtica ou cardÃaca, e nÃo somente durante a fase prÃ-transplante, minimizando as complicaÃÃes clÃnicas no curso do tratamento odontolÃgico trazidas pela doenÃa-base. / The replacement of diseased solid organs by healthy ones was one of the greatest advances in medicine in the last century, becoming viable only with the advent of immunosuppressive drugs, which have the ability to inhibit the response of the recipient against the graft. With the development of immunosuppressive drugs and surgical techniques, post-operative risks have become more known, being infection, mainly bacterial, one of the main reasons for the failure of the transplant. Then, microorganisms present in oral infections become a potential threat, even though they are not commonly cited as post-transplant infections promoters on literature. So, it is essential that dentists known the major oral alterations in these patients, and their needs for treatment in order to adopt a conduct to remove oral infections, and eliminating the postoperative risk. The objective of this study was to assess the oral health status and necessity of dental procedures in a group of solid organ transplant candidates. A cross sectional observational study was realized, collecting data from medical records and by an intra-oral exam, realized by a calibrated examiner. A total of 113 patients were examined, being 71 (62.83%) indicated for renal transplantation, 37 (32.74%) for hepatic and 05 (4.43%) for cardiac. The mean age was 42.13 years, and the most prevalent comorbidity was hypertension. The average DMFT index was 17.27 and the most prevalent Community Periodontal Index (CPI) was 02, found in 56 (49.6%) patients, indicating a high prevalence of gingival bleeding on probing and presence of calculus. Most patients in the study (81.32%) showed no soft-tissue lesions. Evaluating the radiographic exams, 56 (49.5%) individuals had horizontal alveolar bone resorption, and 05 (4.43%) patients had partially erupted third molars. Assessing the necessity of dental treatment, periodontal therapy was indicated in 81.5% of patients, 69.9% had restorative indication, 48.6% needed surgical procedures, and 9.7% had indication for endodontic treatment. There was no statistical difference of variables between the three transplant indications. This study concluded that the examined patients had high prevalence of oral diseases, such as caries and gingivitis/periodontitis, and, therefore, a high indication for dental treatment. Careful clinical evaluation should be performed for patients with indication for surgical procedures, minimizing the hemorrhagic risk. Moreover, there is a necessity to focus on oral health promotion within the medical services in patients with different degrees of renal, liver or heart failure, not only during the pre-transplant period, reducing the clinical complications caused by the systemic disease during dental treatment.

Magister Chirurgiae Dentium - MChD / HIV/AIDS is a major problem in South Africa with more than 25 percent of the adult population infected with HIV. Oral lesions and various opportunistic infections characterize the progression of HIV making it imperative for people living with HIV to have access to good quality oral care. There is a need to examine accessibility and use of dental services in South Africans living with HIV as very little research in this regard, has been undertaken. Aim: To investigate the barriers to oral health care for people living with HIV in the KZN and the WC. Research Design and Methodology: A cross-sectional study utilising a self-administered questionnaire and semi-structured interviews has been employed. Participants were people living with HIV older than 18 years attending HIV clinics located throughout Kwa-Zulu Natal and WC. Binary logistic regression was performed to determine the variables associated with not obtaining care. / South Africa

Introduction: About one in four seniors have periodontal disease and significant disparities have been shown to exist between some population groups. This study aimed to ascertain if differences exist in oral health conditions among statistical zones in Tennessee divided into east, middle and western zones. We also sought to explore factors predicting poor oral health outcomes in these zones. We postulated that oral health would differ between at least two zones in Tennessee and socio-demographic and socio-economic factors would predict oral health outcome. Methods: We combined data from the Behavioral Risk Surveillance System using Data from years 2010, 2012, 2014, 2016 (n= 5181). Outcome variable was number of permanent teeth removed which was ordered as- none, one to five, six or more but not all and all. Zones were divided into East Tennessee comprising- Kingsport-Bristol-Bristol Tennessee-Virginia metropolitan statistical area, Knoxville, Tennessee Metropolitan Statistical Area. Middle/Central Tennessee comprising Chattanooga, Tennessee-Georgia, Metropolitan Statistical Area, Nashville-Davidson-Murfreesboro-Franklin, Tennessee Metropolitan Statistical Area and West Tennessee including Memphis, Tennessee-Memphis-Arizona, Metropolitan Statistical Area. Other independent variables included in our models were general health, could not see a doctor because of cost, history of diabetes, smoked at least 100 cigarettes, use of smokeless tobacco products, adults who had visited a dentist and poor physical health. Covariates were income level, education level, employment status, race/ethnicity, year and marital status. Descriptive statistics and initial univariate analysis were done. Variables significant at alpha level of 0.05 were included in the final adjusted Ordinal Logistic regression model with logit link function. Results: From our sample, 37.1% were males and 67.9% were females. Most (43.4%) were married, most had a high school level of education (34%), most were retired (73.5%) and a higher percentage (12.4%) earned less than 25,000 per annum from all sources. A higher number were White (62.7%), and smokers (51.4%) and 31% had at least one permanent tooth removed. All variables and covariates except poor physical and mental health were significantly associated with the outcome variable (P<0.05). On adjusting for covariates, sex, income, employment status and zone of residence in Tennessee were significantly associated with a difference in the number of permanent teeth removed. The observed difference between the Eastern part of Tennessee and the Western part of Tennessee was significantly. Conclusion: Zone of residence, sex, employment status and income predict oral health outcomes in Tennessee. People in East Tennessee are more likely to have increased permanent teeth removed compared to those in the west.

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