Diss. med. dent. Zürich. / Literaturverz.

Orientador: Renato Moreira Arcieri / Banca: Marcelo de Castro Meneghim / Banca: Suzely Adas Saliba Moimaz / Resumo: O Terceiro Setor vem se destacando desde 1978, principalmente no cenário econômico. É de fundamental importância nos dias atuais, pois alcança um público que há muito estava esquecido e é justamente nesse setor que a Pastoral da Criança iniciou sua atuação. Na cidade de Florestópolis - Pr, em 1983, foi fundada pela Drª. Zilda Arns, médica pediatra e sanitarista, motivada pelo alto índice de mortalidade infantil ocasionado pela desnutrição. Esse terceiro setor é uma imensa rede de solidariedade e a maior organização não governamental do mundo nas áreas de saúde e nutrição infantil. A Pastoral da Criança não pode atuar em outros países, não podendo transferir recursos, por ser um organismo nacional filantrópico. A Pastoral da Criança conta efetivamente com a atuação dos Líderes Comunitários frente às suas ações que é reconhecida como importante elo do processo de construção do capital social. Este trabalho pretende avaliar o Perfil do Líder Comunitário da Pastoral da Criança da Região Norte da cidade de Londrina - Paraná. A primeira parte deste trabalho apresenta um breve histórico da Pastoral da Criança e suas ações básicas, complementares e opcionais, especialmente ações de prevenção e educação em saúde bucal. O projeto piloto do programa de saúde bucal iniciou-se em Campo Largo - PR, por meio de um convênio de cooperação técnica entre Universidade Estadual de Londrina (UEL), CRO-Pr, Prefeitura Municipal de Campo Largo e Pastoral da Criança, no ano de 1993. Nesse acordo, a UEL ficaria responsável pela capacitação dos líderes comunitários para atuar nas comunidades, sendo que a atuação deles seria a de acompanhar a família assistida pela Pastoral da Criança ...(Resumo completo, clicar acesso eletrônico abaixo). / Abstract: The Third Sector has been gaining importance since 1978, mainly in the economic context. This is of fundamental importance nowadays as it focuses on a type of public which had long been forgotten. The Children's Pastoral starts its work exactly at this point. It was founded in Florestópolis, in 1983, by Dr Zilda Arns, a pediatrician and sanitary doctor who was worried about the high indexes of infant mortality in the city. This Third Sector is a huge net of solidarity and it is considered the biggest non-governmental organization in the world concerning infant's health and nutrition. However, it cannot operate in other countries or transfer funds as it is considered a national philanthropic organism. The job of the Community leaders in the Children's Pastoral can be recognized as an important element in the process of the construction of the social capital which has been generated as the result of the action of the pro-developmental society. This work aims to evaluate the profile of the Community Leader of the Children's Pastoral in the northern region of the city of Londrina - PR. The first part of this work is presented with a brief background history of the Children's Pastoral and its basic, complementary and optional actions, especially those related to the prevention and education of dental health. The pilot project of the dental health program started in 1993, in Campo Largo - Pr and it was based on a technical and cooperative partnership between the State University of Londrina, CRO-Pr, the City Hall of Campo Largo and the Children's Pastoral. The State University of Londrina agreed to be responsible for training the community leaders to work in the communities by accompanying the assisted family ...(Complete abstract, click electronic address below). / Mestre

Made available in DSpace on 2014-06-11T19:27:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-03-09Bitstream added on 2014-06-13T19:56:34Z : No. of bitstreams: 1 lima_a_me_araca.pdf: 211547 bytes, checksum: 1e8dc097c567e7502301f2c541290250 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O Terceiro Setor vem se destacando desde 1978, principalmente no cenário econômico. É de fundamental importância nos dias atuais, pois alcança um público que há muito estava esquecido e é justamente nesse setor que a Pastoral da Criança iniciou sua atuação. Na cidade de Florestópolis - Pr, em 1983, foi fundada pela Drª. Zilda Arns, médica pediatra e sanitarista, motivada pelo alto índice de mortalidade infantil ocasionado pela desnutrição. Esse terceiro setor é uma imensa rede de solidariedade e a maior organização não governamental do mundo nas áreas de saúde e nutrição infantil. A Pastoral da Criança não pode atuar em outros países, não podendo transferir recursos, por ser um organismo nacional filantrópico. A Pastoral da Criança conta efetivamente com a atuação dos Líderes Comunitários frente às suas ações que é reconhecida como importante elo do processo de construção do capital social. Este trabalho pretende avaliar o Perfil do Líder Comunitário da Pastoral da Criança da Região Norte da cidade de Londrina - Paraná. A primeira parte deste trabalho apresenta um breve histórico da Pastoral da Criança e suas ações básicas, complementares e opcionais, especialmente ações de prevenção e educação em saúde bucal. O projeto piloto do programa de saúde bucal iniciou-se em Campo Largo - PR, por meio de um convênio de cooperação técnica entre Universidade Estadual de Londrina (UEL), CRO-Pr, Prefeitura Municipal de Campo Largo e Pastoral da Criança, no ano de 1993. Nesse acordo, a UEL ficaria responsável pela capacitação dos líderes comunitários para atuar nas comunidades, sendo que a atuação deles seria a de acompanhar a família assistida pela Pastoral da Criança.... / The Third Sector has been gaining importance since 1978, mainly in the economic context. This is of fundamental importance nowadays as it focuses on a type of public which had long been forgotten. The Children's Pastoral starts its work exactly at this point. It was founded in Florestópolis, in 1983, by Dr Zilda Arns, a pediatrician and sanitary doctor who was worried about the high indexes of infant mortality in the city. This Third Sector is a huge net of solidarity and it is considered the biggest non-governmental organization in the world concerning infant's health and nutrition. However, it cannot operate in other countries or transfer funds as it is considered a national philanthropic organism. The job of the Community leaders in the Children's Pastoral can be recognized as an important element in the process of the construction of the social capital which has been generated as the result of the action of the pro-developmental society. This work aims to evaluate the profile of the Community Leader of the Children's Pastoral in the northern region of the city of Londrina - PR. The first part of this work is presented with a brief background history of the Children's Pastoral and its basic, complementary and optional actions, especially those related to the prevention and education of dental health. The pilot project of the dental health program started in 1993, in Campo Largo - Pr and it was based on a technical and cooperative partnership between the State University of Londrina, CRO-Pr, the City Hall of Campo Largo and the Children's Pastoral. The State University of Londrina agreed to be responsible for training the community leaders to work in the communities by accompanying the assisted family ...(Complete abstract, click electronic address below).

Made available in DSpace on 2014-12-17T15:30:50Z (GMT). No. of bitstreams: 1 LailsonSL.pdf: 806488 bytes, checksum: 9c6790615be4d8d2d3b2adaa92646828 (MD5) Previous issue date: 2007-08-28 / The hospitalization is an event that can attack any person, independent of gender, race, social and economical condition. Last year, the prevalence of hospitalization was 8.1 for 100 inhabitants and the average time of hospitalization was 8.5 days for each patient one in Natal city. Therefore, an important point is whether the attention to the patients during the permanence in these health establishments incorporates the health integral model suggested by the principles proposed by the National Health System in Brazil (SUS), with actions of promotion and protection by different kinds of professionals, beside those called convalescence. Then, the aim of this study was to evaluate the patient s oral health conditions hosted in public hospitals of the Natal city, looking for to establish its relationship with several risk factors by two dimensions: the characteristics of the hospitalization and the patient s general and economical conditions. We accomplished a cross-sectional study with 205 patients distributed among the hospitals Onofre Lopes, Giselda Trigueiro and Monsenhor Walfredo Gurgel, looking for to know the socio-demographic characteristics, the food habits and of oral hygiene and the conditions of oral health, through the Visible Plaque Index and Gingival Bleeding Index. We observed that the conditions of the patient s oral health interned at public hospitals of reference of the municipal district of Natal is bad, existing accumulation of dental plaque and, consequently, a great number of patients with gingival bleeding. However, the time of hospitalization and its reason, the type of medicine used in this time and the toothbrush frequency were not configured as risk factors for this oral health condition / A hospitaliza??o ? um evento que pode atingir qualquer indiv?duo, independente de sexo, ra?a, condi??o social e econ?mica. Em 2006, no munic?pio de Natal, a preval?ncia de internamento foi de 8,1 internamentos para cada 100 habitantes e uma m?dia de perman?ncia no ambiente hospitalar de 8,5 dias para cada paciente. Diante disso, nos questionamos se os cuidados com a Sa?de Bucal dos pacientes durante a estadia nestes estabelecimentos de sa?de incorpora o modelo integral ? sa?de sugerido pelo reordenamento dos servi?os e a??es em sa?de proposto pelo SUS, existindo a??es multiprofissionais de promo??o e de prote??o da Sa?de, ao lado daquelas propriamente ditas de recupera??o. Assim, a proposta deste estudo foi a de avaliar a situa??o de higiene bucal a partir da quantidade de biofilme acumulado das superf?cies dent?rias e da quantidade de sangramento gengival de pacientes hospitalizados em hospitais p?blicos da cidade do Natal. Al?m disto, buscamos estabelecer a associa??o entre a situa??o de sa?de bucal com as caracter?sticas da interna??o e com as condi??es socioecon?micas do paciente. Para isto, realizamos um estudo epidemiol?gico do tipo transversal com 205 pacientes distribu?dos entre os hospitais Onofre Lopes, Giselda Trigueiro e Monsenhor Walfredo Gurgel, buscando conhecer as caracter?sticas s?cio-demogr?ficas, os h?bitos alimentares e de higiene bucal e as condi??es de sa?de bucal, atrav?s dos ?ndices de Placa Vis?vel (IPV) e de Sangramento Gengival (ISG). Observamos que, de uma maneira geral, as condi??es de sa?de bucal dos pacientes internados em hospitais p?blicos de refer?ncia do munic?pio de Natal s?o prec?rias, existindo grande ac?mulo de biofilme dent?rio (placa bacteriana) e, conseq?entemente, um grande n?mero de pacientes com sangramento gengival. Entretanto, o tempo de internamento, o motivo da hospitaliza??o, o tipo de medicamento utilizado e a freq??ncia de escova??o n?o se configuraram como fatores associados com a piora das condi??es de sa?de bucal, sendo necess?rios estudos mais adequados para o estudo desta rela??o

Made available in DSpace on 2014-12-17T15:30:56Z (GMT). No. of bitstreams: 1 SonemyVAP_DISSERT.pdf: 529055 bytes, checksum: 187a196865790ac0d19f46dcd0b896a1 (MD5) Previous issue date: 2000-02-25 / The objective of this study was to evaluate a baby dentistry program which has been in the city of Natal for five years. The research was based on two analysis: a quantitative one, which tried to check caries prevalence in 52 children supported by the program and a qualitative one, which, through interviews carried out with the mothers, using the focus group technique, tried to realize the effect of the program their attitudes related to the care of their children?s oral health. For the quantitative analyses of caries prevalence there was the use of def-s and knutson rates and the values obtained were shown in a descritive and analytical way.The results showed that 4.2% of babies ranging 24 to 36 months old presented carie disease. Children from 36 to 48 months old and above 48 months old presented 18.2% and 16.7% carie prevalence respectively.The def-s averages found in ages 24 to 36, 36 to 48 and 48 to 60 months old were 0.08; 0.40 and 1.16 respectively, considered as being equally low, going along with Knutson rates. The qualitative analyses showed a high level of the mothers` satisfaction, considering the access,practitioner-patient relationship and opportunity to keep the oral health. Children supported by the program showed a low carie prevalence and the program turned out to be effective under the mothers` point of view / O presente estudo teve como objetivo avaliar um programa de odontologia para beb?s em funcionamento h? cinco anos na cidade do Natal. A pesquisa foi pautada em duas an?lises, uma quantitativa que buscou verificar a preval?ncia de c?rie em 52 crian?as acompanhadas pelo programa e outra qualitativa que atrav?s de entrevistas feitas com as m?es, pela t?cnica de grupo focal, procurou apreender o efeito do programa nas atitudes relacionadas aos cuidados em sa?de bucal de seus filhos. Para a an?lise quantitativa da preval?ncia de c?rie foram aplicados os ?ndices CEO-d, CEO-s e Knutson e os valores obtidos apresentados de forma descritiva e anal?tica. A an?lise qualitativa do discurso das m?es foi feita segundo BARDIN. Os resultados apontaram que 4,2% dos beb?s de 24 a 36 meses apresentaram a doen?a c?rie. As crian?as de 36 a 48 meses e de 48 a 60 meses apresentaram respectivamente uma preval?ncia de c?ries de 18,2 e 16,7%. A an?lise qualitativa revelou um alto grau de satisfa??o das m?es relacionado ao acesso, rela??o profissional-paciente e possibilidade de manuten??o da sa?de bucal de seus filhos

Neste estudo foi avaliado o efeito de uma formulação de dentifrício líquido com pH acidulado e baixa concentração de flúor (F) na prevenção de novas lesões cariosas e na incorporação de F no biofilme dentário e nas unhas. Foram selecionadas 1.402 crianças com idade inicial de 4 anos e experiência de cárie, as quais foram divididas em 4 grupos que diferiram em relação ao dentifrício utilizado por 20 meses: G1dentifrício líquido (1100 ppmF, NaF, pH 4,5, n=345), G2 - dentifrício líquido (1100ppmF, NaF, pH 7,0, n=343), G3 - dentifrício líquido (550 ppmF, NaF, pH 45, n=354), G4 pasta comercial Sorriso Fresh (controle -1100 ppmF, NaF, pH 7,0, n=360. A pasta comercial e os dentifrícios experimentais foram dispensados na escova usando as técnicas transversal e da gota , respectivamente. A progressão de cárie (ceo-s) foi avaliada no início do estudo e após 12 e 20 meses de uso contínuo dos dentifrícios. Uma subamostra de cada grupo participou na segunda etapa do estudo, conduzida 15 meses após o início da primeira etapa. Após as unhas das mãos e dos pés terem sido deixadas crescer por 14 dias, foram coletadas unhas das mãos e dos pés em duas ocasiões separadas (n=15 para cada grupo). Amostras de biofilme dentário foram coletadas 1 h após a última utilização dos respectivos dentifrícios (n=21 por grupo). Biofilme e unhas foram analisados para o F com eletrodo, após difusão facilitada por HMDS. Os dados de ceo-s foram analisados pelo teste Kruskal-Wallis (p <0,05). Os dados do biofilme foram analisados por ANOVA e teste de Tukey, ao passo que os dados das unhas foram analisados por ANOVA a dois critérios de medidas repetidas e teste de Bonferroni (p <0,05). Após 20 meses, 1053 escolares (G1=271, G2=262, G3=250 e G4=270) completaram o estudo. As médias (±DP) do ceo-s no baseline e após 20 meses, e do respectivo incremento para cada grupo foram, respectivamente: G1) 5,07±5,11, 7,13±6,53 e 30,8%; G2) 4,80±5,00, 6,88±6,78 e 31,9%; G3) 5,24±5,37, 7,29±7,27 e 30,5%; G4) 5,05±4,89, 7,13±6,35 e 31,1%. Não houve diferença significativa entre os grupos para nenhuma dessas variáveis. A média (±EP, unidade mmol / Kg de peso seco) das concentrações de F no biofilme foram 3,091±0,984a, 1,667±0,410a, 1,448±0,303a e 0,405±0,103b para G1, G2, G3 e G4, respectivamente. As [F]s nas unhas das mãos foram significativamente mais elevadas quando comparadas às dos pés. As mais altas concentrações de F foram encontradas para a pasta comercial, diferindo significativamente dos dentifrícios líquidos. As menores [F]s foram encontradas para o dentifrício de 550 ppm F, diferindo significativamente dos demais dentifrícios. Os dentifrícios líquidos de 1100 ppm F levaram a [F]s intermediárias nas unhas e não diferiram significativamente um do outro. Os resultados sugerem que o dentifrício de baixa concentração de F (550 ppm) e pH acidulado tem a mesma eficácia anti-cáries que os dentifrícios convencionais (1100 ppm F). A redução do pH do dentifrício aumenta a incorporação de F no biofilme sem afetar a concentração de F nas unhas. Portanto, o uso do dentifrício de baixa concentração de F e pH acidulado parece ser uma boa alternativa para prevenir cárie dentária e reduzir a ingestão de F a partir do dentifrício em crianças pequenas. / The purpose of this study was to evaluate the efficacy of a liquid dentifrice with reduced pH and low fluoride concentration for the prevention of new carious lesions and fluoride uptake in dental biofilm and nails. One thousand four hundred and two 4-year-old schoolchildren with caries experience were randomly allocated to 4 groups, differing according to the dentifrice used for 20 months: G1liquid dentifrice (1,100 ppmF, NaF, pH 4.5, n=345), G2-liquid dentifrice (1,100 ppmF, NaF, pH 7.0, n=343), G3-liquid dentifrice (550 ppmF, NaF, pH 4.5, n=354), G4-commercial toothpaste (control-1,100 ppmF,NaF, pH 7.0, n=360). The liquid dentifrices and toothpaste were applied to the toothbrush using the drop and transverse techniques, respectively. Caries progression (dmfs) was evaluated at baseline and after 12 and 20 months of continuous use of the dentifrices. A subsample of each group participated in the second section. Fingernails and toenails were clipped in two separate occasions, after being allowed to grow for 14 days (n=15 for each group). Plaque samples were collected 1 hr after the last use of the respective dentifrices (n=21 for each group). Plaque and nails [F]s were analyzed with the electrode, after HMDS-facilitated diffusion. dmfs data were analyzed by Kruskal-Wallis test (p<0,05).Plaque data were tested by ANOVA and Tukey\'s test, while nails data were analyzed by two-way repeated-measures ANOVA and Bonferroni\'s test (p<0.05). Results: 1,053 children were examined after 20 months (271, 262, 250 and 270 children for G1, G2, G3 and G4, respectively). Mean dmfs(±SD) at baseline, after 20 months and % increment were, respectively: G1) 5.07±5.11, 7.13±6.53 and 30.8%; G2) 4.80±5.00, 6.88±6.78 and 31.9%; G3) 5.24±5.37, 7.29±7.27 and 30.5%; G4) 5.05±4.89, 7.13±6.35 and 31.1%. No significant differences were found among the groups for all the variables tested. Mean (±se, unit mmol/Kg dry weight) plaque [F]s were 3.091±0.984a, 1.667±0.410a, 1.448±0.303a 0.405±0.103b for G1, G2, G3 and G4, respectively. Fingernails [F]s were significantly higher when compared to toenails. The highest [F]s were found for that significantly differed from the experimental liquid dentifrices, except for A (toenails only). The lowest [F]s were found for C, which significantly differed from all the other dentifrices. The experimental 1,100 ppm F dentifrices led to intermediary [F]s in nails and did not significantly differ from each other. Conclusions: The results suggest that the low-fluoride (550 ppm F) acidic dentifrice has the same anticaries effectiveness as the conventional 1,100 ppm F dentifrices. The reduction of the dentifrice pH increases the F uptake in dental plaque and does not affect nails [F]s. Thus, the use of low-fluoride acidic dentifrices seems to be a good alternative to prevent dental caries and reduce the F intake from dentifrice in small children.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-05-19T14:31:23Z No. of bitstreams: 2 Dissertação Marilia Oliveira Morais - 2013.pdf: 1820357 bytes, checksum: f5d19dc55daf286af2de46f79df8659f (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-05-19T14:32:53Z (GMT) No. of bitstreams: 2 Dissertação Marilia Oliveira Morais - 2013.pdf: 1820357 bytes, checksum: f5d19dc55daf286af2de46f79df8659f (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2016-05-19T14:32:53Z (GMT). No. of bitstreams: 2 Dissertação Marilia Oliveira Morais - 2013.pdf: 1820357 bytes, checksum: f5d19dc55daf286af2de46f79df8659f (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-08-23 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Therapeutic modalities for the treatment of oral cancer result in local adverse effects that can cause interruptions of the radiotherapy and consequently to influence in the patient survival. For the reduction and control of the adverse effects, Dental Care Protocol is applied to patients with oral cancer by dental surgeon team before, during and after radiotherapy and chemotherapy. Objective: The aim of this study was to investigate the adhesion of patients with oral cancer to a Dental Care Protocol and its Impact in the interruption and survival. Patients and methods: In this study 133 cases of oral cancer undergoing radiotherapy were selected. The patients were classified according to the period of dental adhesion: no adhesion (group I), adhesion less than or equal to 6 months (group II) and adhesion higher than 6 months (group III). Clinic and pathological aspects, occurrence of interruption of radiotherapy, disease-free survival and overall survival were investigated. Results: The incidence of radiotherapy interruption due to symptoms was statistically significant in group III compared to group I (p = 0.01). The frequency and duration of interruption due to symptoms were not statistically significant between groups. The conclusion of radiotherapy rate was statistically significant in the group that exceeded 6 months of dental adhesion (p = 0.02). Patient’s survival was higher in group III (p = 0.01) when compared to the other groups. Conclusion: The adhesion to a dental care protocol did not have any impact on the radiotherapy interruption due to the occurrence of symptoms, however, patients who had higher adhesion to the Dental Care Protocol showed a higher rate of disease-free survival and overall survival. / Modalidades de tratamentos para o câncer de cavidade oral resultam em efeitos adversos locais que podem gerar interrupções da radioterapia e consequentemente influenciar na sobrevida do paciente. Para a redução e controle dos efeitos adversos, protocolos de preparo do paciente oncológico são estabelecidos por equipes odontológicas antes, durante e pós-tratamento radioterápico e quimioterápico. Objetivo: Verificar a adesão dos pacientes portadores de câncer de cavidade oral ao protocolo preventivo odontológico e seu impacto na interrupção da radioterapia e sobrevida do paciente. Pacientes e método: Neste estudo foram selecionados 133 casos de câncer de cavidade oral submetidos à radioterapia. Os pacientes foram classificados de acordo com o tempo de adesão odontológica: sem adesão (grupo I), adesão inferior ou igual a 6 meses (grupo II) e adesão superior a 6 meses (grupo III). Foram investigadas as características clínico-patológicas, ocorrência de interrupção da radioterapia, sobrevida livre de doença e sobrevida global. Resultados: A ocorrência de interrupção por sintomas foi estatisticamente significante no grupo III quando comparado ao grupo I (p=0,01). A frequência e a duração de interrupção por sintomas não foram estatisticamente significante entre os grupos. A conclusão da radioterapia foi estatisticamente significante no grupo com adesão superior a 6 meses (p=0,02). A sobrevida dos pacientes foi maior no grupo III (p=0,01) quando comparado aos demais grupos. Conclusão: A adesão ao protocolo não teve impacto sobre interrupção da radioterapia devido ocorrência da interrupção por sintomas, no entanto, pacientes que tiveram adesão ao protocolo preventivo odontológico apresentaram um melhor índice de sobrevida livre de doença e de sobrevida global.

RESUMO Este estudo avaliou a influência da educação precoce em saúde bucal do núcleo familiar e do uso de dentifrícios fluoretados sobre a prevalência de cárie dentária na primeira infância. Foram compostos dois grupos de crianças na faixa etária de 6 a 30 meses, diferindo entre si quanto ao acesso à atenção odontológica. O grupo I foi formado por 152 crianças pertencentes ao Projeto Odontobebê (Universidade Federal do Pará), enquanto o grupo II constituído por 94 crianças que não haviam recebido atendimento odontológico até a data do exame. Foi aplicado um questionário às mães com 19 perguntas a respeito dos hábitos alimentares, condutas de higiene bucal e utilização de dentifrícios fluoretados pelas crianças. Sinais clínicos da doença cárie, incluindo lesões cavitadas e manchas brancas ativas, além da presença de biofilme visível, foram avaliadas através do exame clínico. Os dados coletados foram submetidos à análise estatística, utilizando-se o software estatístico Minitab versão 11.0 com um nível de significância de 5% (P<0.05). Houve diferença estatisticamente significativa entre o número de superfícies cariadas e a extensão das lesões de cárie nos grupos I e II (P< 0.001). Um menor número de crianças com cárie, mancha branca ativa e biofilme visível foi encontrado no grupo I, embora os resultados não tenham se revelado estatisticamente significantes. A atenção odontológica fornecida pelo Projeto Odontobebê influenciou positivamente na prevalência de cárie dentária na primeira infância, pois as crianças com cárie neste grupo apresentaram menor número de superfícies cariadas e lesões menos extensas, com predomínio de cavidades em esmalte, quando comparadas as crianças do grupo II. / SUMMARY This paper has evaluated the influence of early education in oral health care of the family nucleus and the use of fluoridated dentifrices on the prevalence of dental caries in early childhood. Two groups of children were made up from children aged o0 t0 30 months, differing one another as to dentistry attention. Group I was made up with 152 children from “Projeto Odontobebê” (Universidade Federal do Pará), while group II was constituted by 94 children which never given any dental care until the examination date. It was applied a form to mothers with 19 questions about eating and oral hygiene habits and the use of fluoridated dentifrices by children. Clinical signs of caries disease, including cavity lesions and active white spots, besides the presence of visible biofilm were evaluated through clinical examination. The data collected were submitted to statistics analyses with statistics Minitab 11.0 software at 5% of significance level (P<0.05). There was a statistically 114 significant difference between the number of caries surfaces and the extension of caries lesions on groups I and II (P<0.001). A lower number of children with caries, active white spot and visible biofilm was found in group I, although the results had not revealed statistically significant. Dental care attention supplied by “Projeto Odontobebê” has presented a positive influence on the prevalence of dental caries in early childhood, for children with caries in such group presented a lower number of caries surfaces and less extended lesions, with a predominance of cavities in enamel when compared to group II children.

Syfte: Syftet med studien var att undersöka ekonomiska utvärderingar av preventiva metoder som används inom tandvården genom att göra en systematisk litteraturöversikt och besvara frågor om vilka preventiva metoder som analyserats avseende kostnad och effekt samt vilka typer av ekonomiska utvärderingar som analyserats. Material och metod: En sökningsstrategi genomfördes och PubMed, The Cochrane Library och Web of Science utgjorde databaser för litteratursökningen. Inklusions- och exklusionskriterier fastställdes och ett protokoll utgjorde grunden för läsningen av de inkluderade studierna i fulltext. En kritisk granskning av de inkluderade studierna genomfördes genom att använda ett andra protokoll. Resultat: Totalt 38 publikationer om ekonomiska utvärderingar av preventiva metoder som används inom tandvården inkluderades. Studier om kariespreventiva metoder var av övervägande majoritet (n=35) och endast ett fåtal studier utvärderade preventiva metoder för andra sjukdomar (n=3). Den vanligaste preventiva metoden som utvärderades var fissurförsegling (n=8) följt av fluorlackning (n=6) och vattenfluoridering (n=3). Många studier utvärderade kombinerade preventiva metoder (n=12). Typerna av ekonomiska utvärderingar var CEA (n=16) följt av CA/Cost-minimization analysis (n=10), CBA (n=3), en kombination av CEA och CBA (n=5), CUA (n=1) och en kombination av CEA och CA (n=1). Konklusion: Även om studierna om ekonomiska utvärderingar av preventiva metoder som används inom tandvården är betydligt fler än när SBU-rapporterna publicerades så kan ingen generell slutsats beträffande kostnadseffektiviteten dras på grund heterogenitet i design och sätt att analysera. Fler välgjorda studier rekommenderas. / Aims: The aim of this study was to examine economic evaluations of preventive methods used in dentistry by using a systematic review approach and answering questions about which preventive methods used in dentistry that have been analysed regarding costs and effects and what types of economic evaluations that have been conducted. Material and method: A search strategy were conducted and PubMed, The Cochrane Library and Web of Science formed the basis of the literature search. Inclusion- and exclusion criteria were defined and a protocol was made for full-text reading of the included publications. A critical appraisal of the included publications was made using a second protocol. Results: A total of 38 publications on economic evaluations of preventive methods used in dentistry were included. Publications on caries preventive methods were of overwhelming majority (n=35) and only a few publications evaluated preventive methods for other diseases (n=3). The most common evaluated preventive method was pit and fissure sealant (n=8) followed by fluoride varnish (n=6) and water fluoridation (n=3). Most publications evaluated combined preventive methods (n=11). Types of economic evaluations were CEA (n=16) followed by CA/Cost-minimization analysis (n=10), CBA (n=3), a combination of CEA and CBA (n=5), CUA (n=1) and a combination of CEA and CA (n=1). Conclusions: Publications on economic evaluations of preventive methods used in dentistry were considerably more than when the SBU reports were published. Yet, no general conclusions could be drawn regarding cost-effectiveness due to heterogeneity in design and way of analyses. Future well-designed studies are recommended.

The aims of this thesis were to evaluate caries-preventive measures from a societal perspective, to demonstrate the use of resources in preventive dentistry, to develop and discuss techniques suitable for evaluating dental care costs and outcomes, and to test costs and consequences within a health economic decision model adapted to preventive dental care. The thesis is based on three separate studies with three separate cohorts. In the first study, performed at a single dental clinic, analysis was made of data on dental caries progression over four years in 92 adolescents, along with the use of resources for preventive treatment. In the second study, data from the intervention study “Evaluation of caries-preventive measures” (performed between 1995 and 1999 at 26 dental health clinics throughout Sweden) were used for economic evaluation. Three different approaches to calculating unit cost were discussed, each of which reflect the differences in treatment costs as influenced by the practitioner’s level of skill and competence (salary) and by methods of handling overhead cost allocation. These methods seem useful for evaluating costs in cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA). The CEA showed an incremental cost-effectiveness over four years of SEK 2 043* per averted decayed (D) enamel (e) and dentine caries, missing (M) and filled (F) surface (S) (DeMFS). In the third study, 82 19-year-old individuals agreed to participate in a pilot exploratory case-control study. Individuals with high caries experience formed the test group while the control group consisted of individuals with no caries experience. To explore whether any differences existed between these two groups in perceived oral health-related quality of life (OHRQOL), two OHRQOL measures were used. Additionally, the willingness of these individuals to pay (WTP) for a preventive strategy was elicited using the contingent valuation method (CVM) within a cost-benefit approach. Using these WTP values, the cost-benefit analyses showed positive net social benefit (NSB) values for both study groups, meaning that the benefits of prevention exceeded the costs. A new outcome measure, Value of Statistical Oral Health (VOSOH), was also presented. Consideration was also made, within the economic framework fundamental to this thesis, of the trend away from a strictly bio-medical paradigm towards a biopsychosocial perspective. The health economic decision model encompasses a number of different techniques for comparing costs with consequences, each with its own advantages and disadvantages and each with its own field of application. These techniques should be seen as complementary rather than competing. Preventive dentistry plays a central role in Swedish dental health care, and it is important that resources are used properly. Accurate evaluation methods are necessary in order to improve the basis for public decision-making; the methods proposed in this thesis seem to be of potential use in this endeavour. *SEK8.54 = US$1 (December 1999).