Abstract The aim of this review was to evaluate the prevalence of dental caries, periodontal disease, malocclusion, and tooth wear in indigenous in Brazil. A systematic review of observational studies was performed according to the PRISMA guidelines (CRD42020218704). The search strategy involved the electronic databases of Embase, LILACS, PubMed, Web of Science, Scopus, and the CAPES Theses and Dissertations for gray literature. The eligibility criteria consisted of publications that assessed the prevalence of oral conditions in indigenous populations in Brazil. Studies with indigenous people living in urban area were excluded. The risk of bias was evaluated by using JBI Critical Appraisal for prevalence studies. Thirty studies were included in the review, and the majority showed a low risk of bias. A meta-analysis of 20 studies was conducted using the random-effects model and a 95% confidence interval. Several ethnicities were studied in isolation or in groups (n = 7,627 for dental caries; n = 2,774 for periodontal disease; n = 1,067 for malocclusion; n = 150 for tooth wear). The prevalence of caries ranged from 50% among indigenous people aged 18-36 months to 100% among those aged 65–74 years. The prevalence of periodontal disease ranged from 58% to 83%. The prevalence of malocclusion was 43%. Tooth wear was assessed in only one ethnic group and showed a prevalence of 100% in indigenous people aged >18 years. The certainty of evidence assessed by the GRADE system ranged from very low to moderate. This systematic review showed significant differences in the prevalence of dental caries, periodontal disease and malocclusion between indigenous population groups and territories in which indigenous people live.

Aim The aim of this study was to evaluate the association between the sense of coherence (SOC) of parents/guardians and the use of dental services by children who are 12 years old. Methods This is a cross-sectional study conducted in the eastern zone of the city of Manaus, with 358 children enrolled in the 7th grade in the municipal public school system. Data collection was performed through self-administered questionnaires sent to parents/guardians, which contained questions about socioeconomic conditions, use of dental services by children and Antonovsky’s SOC-13 scale. Data were examined by descriptive and bivariate analysis, using the Chi-square test, with a 5% significance level. Results Of the 358 children, 58.4% were female; in addition, 75.4% of the parents/guardians self-reported to be brown and 39.9% of them had a family income of ½ to 1 minimum wage. SOC was categorized as strong SOC and weak SOC by the median. The association between strong or weak SOC and the use of dental services in terms of frequency (p= 0.839) and reason for last visit (p= 0.384), was not significant. Conclusion It was concluded that SOC of parents/guardians and utilization of dental services by children were not associated.

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

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

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

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

Abstract Objective: To analyze the fluoride concentration in the public water supply in Manaus, Brazil. Material and Methods: Water samples were collected in 50 mL polyethylene bottles, identified, and labeled. The collection was performed from September 2016 to August 2018. For the selection of collection points, all neighborhoods of the city of Manaus, divided into four health districts (North, South, East, and West), were mapped. From each district, 30 samples were collected, totaling 120 monthly samples. Water samples were analyzed using an ion analyzer, ORION 720-A, and a specific electrode, ORION 96-09. The ion analyzer and electrode were calibrated in standard solutions. The levels were classified in intervals based on technical consensus to guide the health surveillance agencies. Results: Of the 2,874 water samples, 50.3% were within the recommended range, and 49.7% were inadequate, with 31.6% considered above the parameters and 18.1% below. Among the districts, the North had the highest percentages of unsatisfactory samples, resulting in limited action to prevent tooth decay. During the 24 months of analysis, there were large oscillations in the values in all four districts of Manaus. Conclusion: Results reinforce the importance of heterocontrol for the city to guarantee the effectiveness of this public health measure.

Resumo Objetivo Produzir um indicador multidimensional de saúde bucal, a partir de variáveis dentárias e não dentárias, para a pessoa idosa da zona urbana do município de Manaus, AM, Brasil. Método Os dados utilizados são oriundos de um estudo transversal de base populacional conduzido no ano de 2008, com indivíduos de 65 a 74 anos de idade, aleatoriamente selecionados, residentes na cidade de Manaus. Para a produção do indicador proposto, consideraram-se as variáveis dentárias (CPO-D - Índice de Dentes Perdidos, Cariados e Obturados; CPI - Índice Periodontal Comunitário; PIP- Índice de Perda de Inserção Periodontal) e não dentárias (socioeconômicas e índice GOHAI - General Oral Health Assessment Index). Uma Análise Fatorial Exploratória sintetizou essas variáveis, facilitando a construção do indicador multidimensional. Resultados A análise gerou três fatores que, em conjunto, explicaram 72,9% da variância do modelo (KMO = 0,749 e p< 0,001 para o teste de esfericidade de Bartlett). Esses três fatores foram reduzidos à variável “soma”, calculada a partir da soma dos escores fatoriais por indivíduo. A mediana dessa nova variável foi o valor de referência para categorização da condição de saúde bucal do indivíduo em “favorável” ou “desfavorável”. Conclusão O indicador foi capaz de agregar diversas dimensões da saúde bucal em uma única medida, além de possibilitar sua reprodutibilidade para construção de outros indicadores de saúde.

Abstract Objective Produce a multidimensional indicator of oral health, based on dental and non-dental variables, for the older adult in the urban area of the city of Manaus-AM. Method The data used are from a cross-sectional population-based study conducted in 2008 with randomly selected individuals aged 65 to 74 years, residing in the city of Manaus. To produce the proposed indicator, the dental variables (DMFT- Decayed, Missing and Filled Teeth; CPI- Community Periodontal Index; PIP- Periodontal Insertion Loss Index) and non-dental (socioeconomic and index GOHAI- General Oral Health Assessment Index) were considered. An exploratory factor analysis synthesized these variables, facilitating the construction of the multidimensional indicator Results The analysis generated three factors that, together, explained 72.9% of the model’s variance (KMO = 0.749 and p<0.001 for Bartlett’s test of sphericity). These three factors were reduced to the “sum” variable, calculated from the sum of the factor scores per individual. The median of this new variable was the reference value for categorizing the individual’s oral health condition into “favorable” or “unfavorable”. Conclusion The indicator was able to aggregate several dimensions of oral health into a single measure, in addition to enabling its reproducibility for the construction of other health status indicators.

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

OBJETIVO: Avaliar as condições de saúde bucal de gestantes cadastradas no Programa de Humanização no Pré-natal e Nascimento (PHPN) na Unidade Básica de Saúde "Theomário Pinto Costa, situada na zona centro-sul de Manaus-AM". METODOLOGIA: A população estudada foi composta por 50 gestantes, independente do trimestre de gravidez. Para medir a prevalência de cárie utilizou-se o índice CPO-D e para gengivite foram utilizados Índices de Placa e Sangramento Gengival. Por meio de um questionário estruturado foram investigadas as condições socioeconômicas, o acesso aos serviços odontológicos e a autopercepção em saúde bucal. RESULTADOS: A população estudada apresentou 100% de prevalência de cárie com CPO-D médio de 10,0 sendo o componente P (dentes perdidos) predominante na composição do índice (4,28). Das gestantes examinadas, 62% apresentaram inflamação gengival moderada e 64% apresentaram placa mínima. O grau de escolaridade apresentou a seguinte distribuição: 10% ensino fundamental completo; 20% ensino fundamental incompleto; 34% ensino médio completo; 6% ensino superior incompleto. CONCLUSÕES: Diante dos resultados obtidos, pôde-se constatar que as condições de saúde na população de gestantes estudadas foram desfavoráveis; entretanto, a maioria a considerou regular ou boa.

PURPOSE: To evaluate the oral health conditions of pregnant women enrolled in the Prenatal and Birth Humanization Program of the Theomário Pinto Costa primary healthcare unit in the south-central zone of Manaus, Amazonas METHODS: The population comprised 50 pregnant women, independent of pregnancy trimester. To assess the prevalence of dental caries, we used the DMFT Index, and for gingivitis, we used the Plaque Index and Gingival Bleeding Index. A questionnaire was used to investigate socioeconomic conditions, access to dental services and self-perception regarding oral health. RESULTS: One hundred percent of the population presented with caries; the mean DMFT score was 10.0, and the M component (missing teeth) was predominant (4.28). Among the pregnant women examined, 62% presented with moderate gingival inflammation, and 64% presented with at least some plaque. With regard to educational level, 10% of the population had completed an elementary education, 20% had not completed an elementary education, 34% had completed a high school education, and 6% had not completed a university-level education. CONCLUSION: Considering the results, it can be seen that the oral health status of the population was unfavorable, although a majority considered their oral health to be normal or good.

O objetivo deste artigo é analisar o processo de gestão da atenção básica, aí incluído o Programa de Saúde da Família (PSF), em cinco municípios da Amazônia Ocidental. A descentralização, entendida como meio de aprimoramento da gestão local, também foi investigada. Trata-se de um estudo qualitativo, que explorou o plano político-institucional dos sistemas de saúde dos municípios, através das dimensões projeto de governo, capacidade de governo e governabilidade. A coleta de dados foi realizada por meio de técnicas combinadas: análise da documentação oficial dos sistemas municipais de saúde; realização de entrevistas semiestruturadas junto aos gestores municipais de saúde e gerentes intermediários da atenção básica, do PSF e da direção de unidades de saúde (PSF e não PSF) para subsidiar estudo sobre o modelo de gestão e atenção à saúde, e consulta aos sistemas nacionais e municipais de informação. Os resultados mostraram baixa capacidade gestora, dificuldade em definir prioridades para a saúde, inexistência ou incipiência de ações intersetoriais, limitação na autonomia financeira e uma base de apoio político precária; limitada formação técnica dos gestores e de suas equipes, com carência de aperfeiçoamento profissional; quadro técnico dos profissionais da rede de serviços insuficiente em número e em qualificação para efetuar uma gerência qualificada de serviços de atenção primária à saúde.

The objective of this paper was to analyze the primary healthcare management process, including the Programa Saúde da Família (PSF - Family Health Program), in five municipalities located in the western part of the Amazon region. Decentralization, understood as a means of improving the local management, was also investigated. This was a qualitative study that explored the political-institutional level of the municipalities' healthcare systems through the dimensions of government project, government capacity and governability. Data collection was accomplished by means of combined techniques: analysis of official documentation from the municipal healthcare systems; conduction of semi-structured interviews with municipal healthcare managers, managers of the primary healthcare services, of PSF and of the administration of healthcare units (both PSF and non-PSF) to subsidize a study on the healthcare provision and management model; and consultation of the national and municipal information systems. The results showed low management capacity, difficulty in defining healthcare priorities, nonexistent or incipient intersectoral actions, limited financial autonomy and a precarious political support base; limited technical training of managers and their team; insufficient and low-qualified technical staff of the services network, which prevent them from performing a skilled management of primary healthcare.

O objetivo deste artigo é analisar o processo de gestão da atenção básica, aí incluído o Programa de Saúde da Família (PSF), em cinco municípios da Amazônia Ocidental. A descentralização, entendida como meio de aprimoramento da gestão local, também foi investigada. Trata-se de um estudo qualitativo, que explorou o plano político-institucional dos sistemas de saúde dos municípios, através das dimensões projeto de governo, capacidade de governo e governabilidade. A coleta de dados foi realizada por meio de técnicas combinadas: análise da documentação oficial dos sistemas municipais de saúde; realização de entrevistas semiestruturadas junto aos gestores municipais de saúde e gerentes intermediários da atenção básica, do PSF e da direção de unidades de saúde (PSF e não PSF) para subsidiar estudo sobre o modelo de gestão e atenção à saúde, e consulta aos sistemas nacionais e municipais de informação. Os resultados mostraram baixa capacidade gestora, dificuldade em definir prioridades para a saúde, inexistência ou incipiência de ações intersetoriais, limitação na autonomia financeira e uma base de apoio político precária; limitada formação técnica dos gestores e de suas equipes, com carência de aperfeiçoamento profissional; quadro técnico dos profissionais da rede de serviços insuficiente em número e em qualificação para efetuar uma gerência qualificada de serviços de atenção primária à saúde.

The objective of this paper was to analyze the primary healthcare management process, including the Programa Saúde da Família (PSF - Family Health Program), in five municipalities located in the western part of the Amazon region. Decentralization, understood as a means of improving the local management, was also investigated. This was a qualitative study that explored the political-institutional level of the municipalities' healthcare systems through the dimensions of government project, government capacity and governability. Data collection was accomplished by means of combined techniques: analysis of official documentation from the municipal healthcare systems; conduction of semi-structured interviews with municipal healthcare managers, managers of the primary healthcare services, of PSF and of the administration of healthcare units (both PSF and non-PSF) to subsidize a study on the healthcare provision and management model; and consultation of the national and municipal information systems. The results showed low management capacity, difficulty in defining healthcare priorities, nonexistent or incipient intersectoral actions, limited financial autonomy and a precarious political support base; limited technical training of managers and their team; insufficient and low-qualified technical staff of the services network, which prevent them from performing a skilled management of primary healthcare.

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