Made available in DSpace on 2014-06-11T19:33:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-12-12Bitstream added on 2014-06-13T19:22:57Z : No. of bitstreams: 1 diniz_dg_dr_araca.pdf: 1702376 bytes, checksum: 58ba4398f4e8857374b34b777f9a8e9b (MD5) / O objetivo dessa pesquisa-ação foi propor um modelo de acolhimento odontológico (ACO) na estratégia de saúde da família e verificar, na prática, sua utilização como ferramenta facilitadora na organização do acesso aos serviços de saúde bucal. O ACO foi elaborado com foco na reorganização da atenção ao público da demanda espontânea, visando o atendimento de todos os usuários, com o estabelecimento de fluxos e protocolos nos processos de trabalho e de parâmetros de continuidade de tratamento aos pacientes. Num período de 12 meses antes e após a implantação do ACO, foram avaliadas as variáveis referentes às características dos atendimentos realizados, ao perfil da população atendida e à produtividade das equipes de saúde bucal. Os resultados demonstraram que, os atendimentos no ACO, foram, na sua maioria, de usuários que nunca haviam sido atendidos antes na unidade. Os adultos foram a faixa etária predominante. A dor dentária foi a queixa mais citada, sendo a cárie, o principal motivo diagnosticado. Observou-se um agravamento nos riscos de saúde bucal na população atendida nas consultas programadas após a implantação do ACO, em virtude da facilitação do acesso e das medidas de continuidade adotadas. A implementação de fluxos e protocolos possibilitou o aumento da produtividade das equipes. Concluiu-se que o modelo proposto atuou como uma importante porta para a organização do acesso, permitindo a identificação de indivíduos e grupos com maior vulnerabilidade, o que possibilitou um aperfeiçoamento no planejamento, na organização e na implantação de estratégias imediatas de ações em saúde bucal, com tendência ao desenvolvimento de um trabalho mais equânime e universal na localidade / The aim of this action research was to propose a model of dental user embracement (DUE) in the family health strategy and verify, in practice, its use as a tool to help the organization of access to oral health services. The DUE was based on the reorganization of the public's spontaneous demand to meet all users, with establishments fluxes and protocols in the work process and continuity parameters of treatment. In a 12-month period before and after the implementation of the DUE, the variables were assessed regarding the characteristics of dental care, the profile of the population attended and the productivity of oral health teams. The results demonstrated that the DUE were in attendance, mostly from users who never receive dental care on the unit. The adults were the main age group. The tooth pain was the most often cited complaint being, the caries, the main reason diagnosed. It was observed a worsening in the risk of oral health in the population attended in the consultations scheduled after the implementation of DUE, because of easier access and continuity of the measures adopted. The implementation of fluxes and protocols improved the productivity of teams. It was concluded that the proposed model has served as an important gateway to the organization of access, allowing the identification of people and groups with greater vulnerability, allowing an improvement in the planning, organization and implementation of strategies for immediate actions on oral health with tendency to the development of a work more equitable and universal in locality

Esse estudo transversal avaliou a saúde bucal de 36 pacientes com fibrose cística (FC). Um questionário foi aplicado para obter informações sobre autocuidados e outros aspectos que pudessem influenciar os resultados. Os exames, realizados por examinadora treinada e calibrada, foram placa visível (IPV), sangramento gengival (ISG), profundidade de sondagem (PS), perda de inserção (PI), exsudato à sondagem (SS), presença de sítios com cálculo dental, experiência de cárie (ceo/CPO-D + MBA) e número de dentes com sinais de anomalias no esmalte. Os resultados das variáveis clínicas foram comparados (P<0,05), segundo dois extratos de idade e segundo a experiência de cárie positiva (EC+) ou não (EC-), por meio dos testes t de Student ou U de Mann-Whitney. O teste de Spearman foi usado para identificar possíveis correlações entre os achados. Para as idades 12 anos e > 12 anos os resultados foram: IPV (65,40±35,13% e 58,90±34,51%), ISG (14,00±21,61% e 26,51±27,09%) e presença de cálculo dental (21,59±28,96% e 11,97±9,29%), sem diferenças significativas entre os grupos. As médias de PS foram 1,30±0,32mm e 1,70±0,30mm (P=0,00) e de SS foram 3,89±9,92% e 7,72±20,04% (P=0,09). A média de PI, somente presente no grupo >12 anos, foi 0,15±0,35mm. Os valores do índice ceo/CPO-D+MBA foram 1,74±3,33/1,20±1,74 e 5,14±4,26, respectivamente. A presença de anomalias de esmalte variou de nenhum até todos os dentes com sinais, em ambos os grupos. A comparação dos grupos EC+ e EC- revelou que os valores do IPV (70,52±30,92% e 52±37,50%) e ISG (25,13±29,40% e 10,09±10,04%), não diferiram significativamente, ao contrário dos percentuais de cálculo, com valores de 9,97±10,06% e 28,86±32,05% nos grupos, respectivamente. Placa bacteriana (r=0,50; P=0,02), e preferência por alimentos doces (r=0,48; P=0,02) relacionaram-se positivamente com experiência cárie na dentição decídua, assim como o histórico de dor (r=0,48; P=0,03), que também teve relação positiva com a dentição permanente (r=0,52; P=0,02). Correlação positiva foi observada entre a perda de inserção e a percepção da gengiva já ter sangrado anteriormente (r=0,51; P=0,00). Os níveis de escolaridade da mãe e do pai relacionaram-se negativamente com a EC nas crianças FC (r=-0,57; r=-0,71). Conclusões: Nessa amostra, manifestações de cárie foram observadas a partir de sinais incipientes de perda mineral, sendo que a experiência de cárie foi semelhante àquela observada na população do sul do Brasil. A remoção de cálculo dental para tratamento da gengivite não deve ser priorizado no atendimento de pacientes císticos com atividade de cárie. Atenção odontológica deve ser direcionada à prevenção e ao tratamento da doença cárie. / This cross-sectional study assessed the dental health of 36 cystic fibrosis (CF) patients. Questionnaire was applied to obtain information about self-care and other aspects that could influence the results. One trained and calibrated examiner evaluated the presence of visible plaque (VIP), gingival bleeding (GB), bleeding on probing (BOP), pocket depth (PD), clinical attachment loss (CAL), presence of supragingival calculus, dmf/DMF-T index modified by the presence of active white spots, and the presence of enamel defects. The results of the clinical variables were compared (P<0.05), according to two age groups, and according to caries experience (CE), positive (+) or not (-), by Student t test or U Mann-Whitney test. The non-parametric test of Spearman was used to identify possible correlations between findings. The results seen for age’s 12 years old and > 12 years old were: VIP (65.40±35.13% and 58.90 ± 34.51%), GB (14.00±21.61% and 26.51% ± 27.09%) and presence of calculus (21.59±28.96% and 11.97±9.29%), without statistic differences between the groups. The mean value of PS was 1.30±0.32 mm and 1.70±0.30mm (P= 0.00) and BOP were 3.89± 9.92% and 20.04±7.72% (P= 0.09). The CAL mean value present in the group > 12 years old, was 0.15±0.35 mm. The values of the dmf/DMF-T modified index were 1.74 ±3.33 / 1.20 ± 1.74 and 5.14 ± 4.26, respectively. The presence of teeth with enamel defect, per individual, ranged from none to all teeth with signs in both groups. The analysis of the groups CE+ and CE- revealed that VIP (70.52±30.92% - 52.00±37.50%) and of GB (25.13±29.40% -10.09±10.04%), did not differ significantly. Differences were observed between the percentages of dental calculus (9.97±10.06% - 28.86±32.05%). Few significant correlations were observed between the findings. The presence of visible plaque (r= 0.50, P=0.02), and preference for sweet foods (r= 0.48, P=0.02) correlated positively with caries experience in primary dentition, as well as the history of pain (r= 0.48, P=0.03), and that also had positive correlation with the permanent dentition (r= 0.52, P=0.02). Positive correlation was also found between attachment loss and the perception of gingival bleeding by the patient (r= 0.51, P=0.00). Mother’s and father’s education were negatively correlated with CE+ in primary dentition (r= - 0.57, r= - 0.71). Conclusions: In the study, symptoms of decay were observed from the incipient signs of mineral loss, and the caries experience in the cystic patients sample were similar to those observed in the population from south of Brazil. In cystic patients with caries activity, the removal of dental calculus for the treatment of gingivitis should not take priority in the planning of dental care. Dental care should be directed to prevention and treatment of caries.

Orientador: Suzely Adas Saliba Moimaz / Banca: Rogério Nogueira de Oliveira / Banca: Luís Carlos Cavalcante Galvão / Resumo: O Sistema de Auditoria no setor saúde é fundamental, pois permite a avaliação da veracidade das informações e a resolubilidade da prestação de serviços, pressupondo o desenvolvimento de um modelo de atenção adequado. Nesta pesquisa, objetivou-se analisar as atividades da auditoria no Sistema Único de Saúde no serviço de saúde bucal do município de Aquidauana (MS); fazer o levantamento das principais justificativas de glosas e das perdas de produção; analisar as atividades desenvolvidas pelas equipes da Estratégia da Saúde da Família. É um estudo epidemiológico de série histórica retrospectiva, com abordagem quantitativa, entre os anos de 2001 a 2010. Foi realizada análise documental e revisão bibliográfica sobre os sistemas de auditoria e o papel do auditor no serviço odontológico. Para o levantamento dos dados de produção, perdas, justificativas de glosas e cumprimento de metas foram utilizadas respectivamente, o sistema de informação do DATASUS, relatórios realizados pelo Sistema Municipal de Auditoria do município de Aquidauana (MS), relatórios dos indicadores propostos pelos Decretos nº 11.684/2004 e nº 12.005/2005 da Secretaria Estadual de Saúde do Mato Grosso do Sul que estabelece mensalmente o mínimo de 10 visitas domiciliares, 26 tratamentos completados e uma atividade educativa. Os resultados mostraram que a atuação da auditoria é abrangente no gerenciamento do sistema, consistindo no controle, avaliação, supervisão e orientação, bem como na garantia da participação social e acesso aos serviços. Neste período foram apresentados 921.300 procedimentos odontológicos; sendo 223.226 (24,2%) procedimentos individuais e 698.074 (75,8%) coletivos. Ocorreram 23.881 glosas (2,6%), sendo 10.158 (42,5%) nos procedimentos coletivos e 13.723 (57,5%) nos individuais. Constatou-se que a ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Auditing system in public health is furthermost important, as it permits the evaluation of veracity of information and to access the accuracy in delivering services, assuming a model of adequate attention. The research objectives were to analyze auditing activities in oral health from the Single Health System within the municipality of Aquidauana (MS); to find the main justifications for glosses and losses in production; and to analyze activities developed by the strategic family health units. This is an epidemiological study of a retrospective historical series, with a quantitative approach, from 2001 to 2010, with a documental analysis and literature review about the auditing systems and the role of the auditor in odontological services. To compile the data from production, losses in procedures, and justifications for glosses as well as the achievement of targets, the database DATASUS was used, reports from the municipal system of auditing in the municipality of Aquidauana (MS) and reports and indicators from decrees 11,684/2004 and 12,005/2005 from the Health State Office of Mato Grosso do Sul- which establishes a minimum of 10 home visits monthly, 26 treatments completed and one education activity. Results show a broad range of activities from the auditing system in the system management, including activities for control, evaluation, supervision, orientation, and guarantee for social engagement and access to services. In this period there were 921,300 odontological procedures; from which 223,226 (24.2%) were individual procedures and 698,074 (75.8%) were collective procedures. There were 23,881 glosses (2.6%), from which 10,158 (42.5%) happened in collective procedures and 13,723 (57.5%) happened in individual procedures. It was found that the most frequent cause for glosses in individual procedures was the repetition in procedure to the ... (Complete abstract click electronic access below) / Mestre

Orientador: Artênio José Ísper Garbin / Banca: Mônica da Costa Serra / Banca: Renato Herman Sundfeld / Banca: Antonio Carlos Pereira / Banca: Arsenio Sales Peres / Resumo: O objetivo dessa pesquisa-ação foi propor um modelo de acolhimento odontológico (ACO) na estratégia de saúde da família e verificar, na prática, sua utilização como ferramenta facilitadora na organização do acesso aos serviços de saúde bucal. O ACO foi elaborado com foco na reorganização da atenção ao público da demanda espontânea, visando o atendimento de todos os usuários, com o estabelecimento de fluxos e protocolos nos processos de trabalho e de parâmetros de continuidade de tratamento aos pacientes. Num período de 12 meses antes e após a implantação do ACO, foram avaliadas as variáveis referentes às características dos atendimentos realizados, ao perfil da população atendida e à produtividade das equipes de saúde bucal. Os resultados demonstraram que, os atendimentos no ACO, foram, na sua maioria, de usuários que nunca haviam sido atendidos antes na unidade. Os adultos foram a faixa etária predominante. A dor dentária foi a queixa mais citada, sendo a cárie, o principal motivo diagnosticado. Observou-se um agravamento nos riscos de saúde bucal na população atendida nas consultas programadas após a implantação do ACO, em virtude da facilitação do acesso e das medidas de continuidade adotadas. A implementação de fluxos e protocolos possibilitou o aumento da produtividade das equipes. Concluiu-se que o modelo proposto atuou como uma importante porta para a organização do acesso, permitindo a identificação de indivíduos e grupos com maior vulnerabilidade, o que possibilitou um aperfeiçoamento no planejamento, na organização e na implantação de estratégias imediatas de ações em saúde bucal, com tendência ao desenvolvimento de um trabalho mais equânime e universal na localidade / Abstract: The aim of this action research was to propose a model of dental user embracement (DUE) in the family health strategy and verify, in practice, its use as a tool to help the organization of access to oral health services. The DUE was based on the reorganization of the public's spontaneous demand to meet all users, with establishments fluxes and protocols in the work process and continuity parameters of treatment. In a 12-month period before and after the implementation of the DUE, the variables were assessed regarding the characteristics of dental care, the profile of the population attended and the productivity of oral health teams. The results demonstrated that the DUE were in attendance, mostly from users who never receive dental care on the unit. The adults were the main age group. The tooth pain was the most often cited complaint being, the caries, the main reason diagnosed. It was observed a worsening in the risk of oral health in the population attended in the consultations scheduled after the implementation of DUE, because of easier access and continuity of the measures adopted. The implementation of fluxes and protocols improved the productivity of teams. It was concluded that the proposed model has served as an important gateway to the organization of access, allowing the identification of people and groups with greater vulnerability, allowing an improvement in the planning, organization and implementation of strategies for immediate actions on oral health with tendency to the development of a work more equitable and universal in locality / Doutor

Esse estudo transversal avaliou a saúde bucal de 36 pacientes com fibrose cística (FC). Um questionário foi aplicado para obter informações sobre autocuidados e outros aspectos que pudessem influenciar os resultados. Os exames, realizados por examinadora treinada e calibrada, foram placa visível (IPV), sangramento gengival (ISG), profundidade de sondagem (PS), perda de inserção (PI), exsudato à sondagem (SS), presença de sítios com cálculo dental, experiência de cárie (ceo/CPO-D + MBA) e número de dentes com sinais de anomalias no esmalte. Os resultados das variáveis clínicas foram comparados (P<0,05), segundo dois extratos de idade e segundo a experiência de cárie positiva (EC+) ou não (EC-), por meio dos testes t de Student ou U de Mann-Whitney. O teste de Spearman foi usado para identificar possíveis correlações entre os achados. Para as idades 12 anos e > 12 anos os resultados foram: IPV (65,40±35,13% e 58,90±34,51%), ISG (14,00±21,61% e 26,51±27,09%) e presença de cálculo dental (21,59±28,96% e 11,97±9,29%), sem diferenças significativas entre os grupos. As médias de PS foram 1,30±0,32mm e 1,70±0,30mm (P=0,00) e de SS foram 3,89±9,92% e 7,72±20,04% (P=0,09). A média de PI, somente presente no grupo >12 anos, foi 0,15±0,35mm. Os valores do índice ceo/CPO-D+MBA foram 1,74±3,33/1,20±1,74 e 5,14±4,26, respectivamente. A presença de anomalias de esmalte variou de nenhum até todos os dentes com sinais, em ambos os grupos. A comparação dos grupos EC+ e EC- revelou que os valores do IPV (70,52±30,92% e 52±37,50%) e ISG (25,13±29,40% e 10,09±10,04%), não diferiram significativamente, ao contrário dos percentuais de cálculo, com valores de 9,97±10,06% e 28,86±32,05% nos grupos, respectivamente. Placa bacteriana (r=0,50; P=0,02), e preferência por alimentos doces (r=0,48; P=0,02) relacionaram-se positivamente com experiência cárie na dentição decídua, assim como o histórico de dor (r=0,48; P=0,03), que também teve relação positiva com a dentição permanente (r=0,52; P=0,02). Correlação positiva foi observada entre a perda de inserção e a percepção da gengiva já ter sangrado anteriormente (r=0,51; P=0,00). Os níveis de escolaridade da mãe e do pai relacionaram-se negativamente com a EC nas crianças FC (r=-0,57; r=-0,71). Conclusões: Nessa amostra, manifestações de cárie foram observadas a partir de sinais incipientes de perda mineral, sendo que a experiência de cárie foi semelhante àquela observada na população do sul do Brasil. A remoção de cálculo dental para tratamento da gengivite não deve ser priorizado no atendimento de pacientes císticos com atividade de cárie. Atenção odontológica deve ser direcionada à prevenção e ao tratamento da doença cárie. / This cross-sectional study assessed the dental health of 36 cystic fibrosis (CF) patients. Questionnaire was applied to obtain information about self-care and other aspects that could influence the results. One trained and calibrated examiner evaluated the presence of visible plaque (VIP), gingival bleeding (GB), bleeding on probing (BOP), pocket depth (PD), clinical attachment loss (CAL), presence of supragingival calculus, dmf/DMF-T index modified by the presence of active white spots, and the presence of enamel defects. The results of the clinical variables were compared (P<0.05), according to two age groups, and according to caries experience (CE), positive (+) or not (-), by Student t test or U Mann-Whitney test. The non-parametric test of Spearman was used to identify possible correlations between findings. The results seen for age’s 12 years old and > 12 years old were: VIP (65.40±35.13% and 58.90 ± 34.51%), GB (14.00±21.61% and 26.51% ± 27.09%) and presence of calculus (21.59±28.96% and 11.97±9.29%), without statistic differences between the groups. The mean value of PS was 1.30±0.32 mm and 1.70±0.30mm (P= 0.00) and BOP were 3.89± 9.92% and 20.04±7.72% (P= 0.09). The CAL mean value present in the group > 12 years old, was 0.15±0.35 mm. The values of the dmf/DMF-T modified index were 1.74 ±3.33 / 1.20 ± 1.74 and 5.14 ± 4.26, respectively. The presence of teeth with enamel defect, per individual, ranged from none to all teeth with signs in both groups. The analysis of the groups CE+ and CE- revealed that VIP (70.52±30.92% - 52.00±37.50%) and of GB (25.13±29.40% -10.09±10.04%), did not differ significantly. Differences were observed between the percentages of dental calculus (9.97±10.06% - 28.86±32.05%). Few significant correlations were observed between the findings. The presence of visible plaque (r= 0.50, P=0.02), and preference for sweet foods (r= 0.48, P=0.02) correlated positively with caries experience in primary dentition, as well as the history of pain (r= 0.48, P=0.03), and that also had positive correlation with the permanent dentition (r= 0.52, P=0.02). Positive correlation was also found between attachment loss and the perception of gingival bleeding by the patient (r= 0.51, P=0.00). Mother’s and father’s education were negatively correlated with CE+ in primary dentition (r= - 0.57, r= - 0.71). Conclusions: In the study, symptoms of decay were observed from the incipient signs of mineral loss, and the caries experience in the cystic patients sample were similar to those observed in the population from south of Brazil. In cystic patients with caries activity, the removal of dental calculus for the treatment of gingivitis should not take priority in the planning of dental care. Dental care should be directed to prevention and treatment of caries.

Estudos epidemiológicos são a única forma de propiciar uma visão do estado de saúde bucal e necessidades de tratamento de uma população, e as possíveis relações entre os fatores ambientais e a prevalência de cárie. Estudos desta natureza, no Brasil e no mundo, tem sido dirigidos a grupos de estudantes da rede pública ou trabalhadores da indústria ou comércio. Estretanto, face à situação atual de alto desemprego e um grande número de crianças fora da rede escolar, usou-se uma metodologia que permitiu o sorteio de quarteirões de todos os bairros urbanos da cidade de Bauru. Todas as residências dos quarteirões sorteados foram visitadas e 1839 foram examinadas. No levantamento epidemiológico foram examinados 6.539 indivíduos de mais de 3 anos de idade, que foram classificados quanto à idade, sexo, classe socio-economica, nível de escolaridade e atenção odontológica recebida nos últimos doze meses prévios ao exame. Baseados na análise estatística dos resultados, pode-se concluir que: 1 - O padrão de saúde bucal nas faixas etárias testadas, em relação ao número de pacientes isentos de cárie, CPOD, última visita ao dentista, dentes restaurados e cariados mostrou não have diferenças estatisticamente significantes entre os sexos. Entretanto, houve diferenças estatisticamente significantes entre os sexos em relação ao número de dentes perdidos no sub-grupo de 35-44 anos, tendo o sexo feminino perdido mais dentes que o masculino. 2 - O padrão de saúde bucal na faixa etária de 3-4 anos de idade mostrou diferenças estatisticamente significantes entre as classes sociais, tendo as de nível sócio-econômico mais elevado mostrado maior número de crianças com CPOD igual a zero. Já nas faixas etárias de 5-6 e 12-13 anos, esta diferenã não foi observada. Quando o CPOD e o número de dentes perdidos foram considerados para o grupo 12-13 anos, não houve diferença estatisticamente significante entre as distintas classes sociais. Para a faixa etária de 35-44 foi observada uma diferença estatisticamente significante quando ao número de dentes perdidos, sendo que as classes mais privilegiadas perderam menos dentes que as demais. No sub-grupo de 12-13 anos houve diferença estatisticamente significante, tanto para dentes perdidos, sendo que as classes mais privilegiadas perderam menos dentes que as demais. No sub-grupo de 12-13 anos houve diferença estatisticamente significante, tanto para dentes restaurados, quando para dentes cariados. As classes mais privilegiadas mostraram maior número de dentes restaurados, enquanto as demais mostraram maior número de cariados. As comparações entre os nossos dados e as metas estabelecidas pelo OMS para o ano 2.000 apontam para a necessidade do aumento de 38% para 50% de crianças isentas de cárie, a diminuição do CPOD aos 12 anos, de 4,87 para 3 e o aumento do percentual de indivíduos com todos os dentes aos 18 anos, de 51% para 85%. Certamente estes índices não serão conseguidos dentro do modelo atual de atendimento. Atitudes firmes necessitam ser tomadas para reverter o quadro atual. / A sampling survey may be the only feasible method of collecting the relevant data on disease distribution for use in planning and evaluating the communities dental status, dental need and how these states are influenced by the enviroment. Epidemiological investigations in the world and Brazil have been generally directed to more accessible population groups such as school age children or organized groups like factory workers. Howevwe, with the particular situations wich face the population nowadays such as high inflation rate, unemplyment, and a great number of children out of the school system, the sampling selection as performed in two stages. In the first stage, blocks of all the urban districts that divide the city were randomly selected. In the second stage, all the dwellings in each block were selected. Of the 1,927 families visited, 1,839 agreed to be examined, representing a response rate of 95,4 per cent. Examinations were provided for 6,598 individuals from 1,839 families. The subjects were between the ages of 3 and 92 years-old. The individuals were classified according to sex, age, educational level, socio-economic status and having received dental treatment in the last 12 months previous to the examination. To assess the oral health of each individual, information about dentition status and treatment need, prosthetic status and denture requirements as well as conditions needing immediate attention were obtained according the criteria proposed by WHO. According to the experimental conditions of this investigation and based upon on the statistical analysis of the data, the following conclusions were drawn: 1- No significant difference was found by sex in the DMFT score, last visit to the dentist, caries free children, filled or decay score. However, significant differences were detected by sex in the M-D score among the 35-44 age goup, and females presented higher numbers of missing teeth than males. 2 - Significant differences was found among children aged 3-4 in the number of caries free by socio economic status. In the same way, among people of 35-44 years of age, significant difference was found in the number of missing teeth by socio economic status and the M-T is inversely related to the social class; the higher social class the lower the mean number. Significant differences were detected in both the number of filled and decayed teeth among people aged 12-13. With higher social class, the number of filled teeth was higher and the number of decayed teeth was lower. However, no significant differences were found by socio economic status in both DMFT score and missing teeth among the age-groups 5-6, 12-13. 3 - By the comparasion between our data and the WHO\'s desire for the year 2000 to achieve their goals, it will be necessary to improve both the number of carie free children from 38% to 50%, and the number of people who had all of their teeth from 51% to 85%. It will also be necessary at the same time to decrease the DMFT from 4,87 to 3 for 12 years-old people. These goals will not be achieved with the dental care system available nowadays. A change in attitude must be taken to improve the current situation.

Aim: To improve the dental behaviour and knowledge of mothers of infants with cleft lip and/or palate (CLP). Design: A randomised controlled, single blind, prospective clinical trial of one year duration, measuring the effectiveness of a preventive dental health programme. All mothers and their infants attending the regional cleft unit following primary surgery were invited to participate. All data collection took place within the same cleft unit. Primary objectives examined dental attendance, use of a fluoride toothpaste and introduction of a feeder cup. Mothers completed dental behaviour and dental health knowledge questionnaires followed by stratified random allocation concealed from the researcher, to test or control groups. Preventive dental advice was given according to group allocation. Data were collected at baseline, after 12 months and aged three years at a multidisciplinary clinic review. An independent researcher collected the 12 months data and a specialist in paediatric dentistry the data at aged three years, both were blinded to group allocation. Results: 88 infants were recruited with 87 available at 12 months and 82 at three years, median age at baseline 10.5 months. More infants in the test group had been examined by their dentist, 12 months (p = 0.063), 3 years (p = 0.054). More infants in the test group were using a high fluoride toothpaste at 12 months (p = 0.001), no difference was found at three years (p = 0.105). Fewer infants in the test group were consuming drinks considered detrimental between meals at 12 months (p = 0.022), no difference was detected at three years (p = 1.000). A comparison of dental health knowledge over time revealed some differences. The dental health status reported 60 (73%) children were caries free and 17 (21%) with dentinal caries requiring attention. Four children were in need of dental extractions under general anaesthesia. This study was not powered to detect important differences between groups. The mean caries experience, decayed, missing and filled teeth (dmft) for 82 children examined at three years was 0.51(SD 1.45) and for those 17 (21%) with caries into dentine, 2.47 (SD 2.35). Conclusion: A dental health programme initially changes behaviour, however over time this is not maintained. Due to moderate caries levels the regional cleft Unit should ensure that all children with CLP receive preventive dental advice and dental care from either a hospital or community based specialist in paediatric dentistry. Further research is needed to improve the future care of this important group.

Philosophiae Doctor - PhD / The rhetoric of primary health care, health promotion and health service integration is ubiquitous in health policy development in post-apartheid South Africa. However the form in which oral health promotion elements have actually been incorporated into other areas of health care in South Africa and the extent to which they have been implemented, remains unclear. The central aim of this research was to critically analyse oral health promotion elements in health policies in South Africa and determine the extent to which they have been implemented. The study set out to test the hypothesis that oral health promotion is fully integrated into South African health policy and practice. / South Africa

A cocaína, alcalóide extraído das folhas da Erythroxylon coca, planta nativa das regiões andinas, vem sendo consumida a cada dia com maior frequência e em camadas etárias cada vez menores. As vias de auto-administração podem ser intranasal, oral, intravenosa e respiratória. As consequências bucais da sua utilização são observadas na redução da capacidade tampão da saliva, índice CPOD elevado, xerostomia, bruxismo, doença periodontal, halitose e estomatites. As alterações bucais, como lesões de cárie, desgaste dentário, retração gengival, lesões na mucosa, são ocorrências comuns, proveniente da sua ação vasoconstritora e da diminuição do pH da saliva. Objetivos: Este estudo descritivo de corte transversal avaliou a saúde bucal de usuários de cocaína e/ou crack em três áreas da cidade de Salvador, utilizando-se dos índices CPOD (dentes cariados, perdidos e obturados), PIP (perda de inserção periodontal) e CPI (avaliação periodontal comunitário). Método: A amostra constituiu-se de 52 usuários de cocaína e/ou crack, com idade média de 30,96 anos, assistidos pela Aliança de Redução de Danos Fátima Cavalcanti (ARD-FC). Realizou-se a análise descritiva e exploratória da população estudada segundo: características sociodemográficas, características biológicas gerais e de saúde bucal, características comportamentais e assistência odontológica. Resultados: Os usuários apresentaram baixo nível sociodemográfico caracterizado pela baixa escolaridade, alta taxa de desemprego e falta de moradia fixa. A associação concomitante com tabaco, álcool e maconha foi evidente; a principal via de administração para cocaína foi intranasal enquanto que para o crack, a via fumada; revelou-se alto consumo de açúcar, refrigerantes e café. Verificou-se a ocorrência de xerostomia (36,5%) e refluxo gastroesofágico (32,7%). O índice CPOD foi em média de 14,81, com 61,5% de indivíduos examinados com cálculo dental e 46,1% de indivíduos com perda de inserção gengival de 4 a 5mm. Conclusões: Os dados obtidos indicam que não apenas o uso da cocaína e/ou crack, mas a associação com outros indicadores avaliados é determinante para o baixo índice de saúde bucal. / Cocaine, an alkaloid extracted from the leaves of the Erythroxylon coca, a plant originated in the regions of the Andes heights, has been consumed more and more frequently and by younger and younger age groups as well. Its intake occurs in different ways such as, intranasal, oral, intravenous and respiratory. The buccal consequences derived from its use are noticed by means of reducing the saliva buffer capacity, high DMFT index, xerostomia, grinding of teeth, periodontal disease, halitosis and stomatitis. Buccal alterations such as decay lesion, wear of teeth, gingival retraction, mucosal legions are common occurrences resulting not only from cocaine vasoconstrictor action but also from saliva PH decrease. Objectives: This cross-section descriptive study aimed mainly at evaluating the three different areas of Salvador City using the DMFT indices (decayed teeth, either lost or filled), PIP (losing of periodontal insertion) and CPI (communitarian periodontal insertion index). Method: The sample consisted of 52 subjects, all of them cocaine and/or crack users, aged 30,96 years old in average, assisted by the Aliança de Redução de Danos Fatima Cavalcanti (ARD-FC). A descriptive and exploratory analyses of the population were studied according to socio-demographic characteristics, general biological characteristics and those of dental health, dental behavior characteristics and dental assistance as well. Results: The users showed a low socio-demographic level characterized by poor schooling, high unemployment rate and permanent homelessness. The concomitant association with tobacco, alcohol and marijuana was quite evident; the main channel for cocaine intake was the intranasal one whereas the one for crack was that by means of smoking it. A high absortion of sugar, softdrinks and coffee was revealed. An occurrence of xerostomia (36,5%) and another of gastroesophageal reflux (32,7%) were detected. The index of DMFT was 14,81 in average: 61,5% of the subjects who were examined had dental calculi and 46,1% and loss of 4-5mm gingival insertion. Conclusions: The data obtained in this study point out that not only the use of cocaine and/or crack alone but also its association with other evaluated indicators is determinant of the low dental health index.

Previous studies suggest that Medicaid-enrolled children have difficulties accessing dental care, which can lead to untreated dental disease, poor oral health, and compromised overall health status. While Medicaid-enrolled children with a chronic condition (CC) encounter additional barriers to dental care, most relevant studies on dental utilization fail to adopt risk adjustment methods. As such, the impact of CC status and CC severity on access to dental care for Medicaid-enrolled children is poorly understood. The main objectives of this dissertation were to: 1) compare dental utilization for Medicaid-enrolled children with and without a CC; 2) assess the relationship between CC severity and dental utilization; and 3) identify the other factors associated with dental utilization. The 3M Clinical Risk Grouping (CRG) Methods were applied to enrollee-level data from the Iowa Medicaid Program (2003-2008) to identify children with and without a CC and to classify children with a CC into a CC severity level. Three outcome measures were developed: 1) access to an annual dental visit; 2) use of dental services under general anesthesia (GA); and 3) time to the first dental visit after initial enrollment into the Medicaid program. We used multiple variable logistic regression models and survival analytic techniques to test our study hypotheses. Compared to Medicaid-enrolled children without a CC, those with a CC were more likely to have had an annual dental visit and earlier first dental visits. Having a CC was an important determinant of dental utilization under GA for older but not for younger Medicaid-enrolled children. In terms of CC severity, Medicaid-enrolled children with more severe CCs were less likely to have had an annual dental visit and more likely to have utilized dental services under GA. CC severity was not associated with the rate at which the first dental visit took place. Not residing in a dental Health Professional Shortage Area, previous use of dental care, and previous utilization of primary medical care were all positively associated with dental utilization. Identifying and understanding the determinants of access to dental care is an important first step in developing clinical interventions and policies aimed at improving access to dental care for all Medicaid-enrolled children. Future work should focus on identifying the socio-behavioral determinants of as well as the clinical outcomes associated with access to dental services for vulnerable children.