O estresse e a discriminação afetam negativamente a qualidade de vida, mas o apoio social pode amortecer seus efeitos. Os objetivos deste estudo são: (1) examinar as associações entre estresse psicológico, discriminação e qualidade de vida relacionada à saúde bucal (QVRSB); e (2) avaliar se apoio social, estresse e discriminação interagem para modificar suas associações com QVRSB. Os dados são de uma pesquisa transversal de base domiciliar de um estudo que incluiu 396 indivíduos com 14 anos ou mais de famílias registradas para benefícios federais em uma cidade no sul do Brasil. A QVRSB foi mensurada pelo Impactos Orais no Desempenho Diário (OIDP), enquanto o estresse psicológico foi avaliado pela Escala de Estresse Percebido (PSS). Além disso, o apoio social foi avaliado pelo número de parentes ou amigos próximos e a discriminação por meio da Escala de Discriminação Diária (EDS). As interações foram estimadas por meio do excesso relativo de risco devido à interação (RERI). Os efeitos ajustados foram calculados por meio de regressão logística. A prevalência de impactos bucais entre as pessoas com maior e menor escores de PSS foi de 81,6% e 65,5%, respectivamente (p < 0,01). O apoio social mostra interações inclusivas com níveis de estresse e discriminação. A associação entre discriminação social e QVRSB (escore OIDP > 0) foi OR = 2,03 (IC95%: 1,23; 3,34) dentre pessoas com baixo nível de estresse, mas foi de OR = 12,6 (IC95%: 1,31; 120,9) dentre aqueles com níveis mais altos (p = 0,09, para interação). Indivíduos que relataram níveis mais elevados de estresse psicológico e discriminação apresentaram pior QVRSB; o efeito sinérgico com o apoio social não foi evidente.

Stress and discrimination negatively affect quality of life, but social support may buffer their effects. This study aims: (1) to examine the associations between psychological stress, discrimination, and oral health-related quality of life (OHRQoL); and (2) to assess whether social support, stress and discrimination interact to modify their associations with OHRQoL. We used cross-sectional household-based data from a study including 396 individuals aged 14 years and over from families registered for government social benefits in a city in Southern Brazil. OHRQoL was measured with the Oral Impacts on Daily Performance (OIDP) scale; psychological stress was assessed with the Perceived Stress Scale (PSS); social support was assessed based on the number of close relatives or friends of the participant, and discrimination was assessed with a short version of the Everyday Discrimination Scale. Interactions were estimated using the relative excess of risk due to interaction (RERI). Adjusted effects were calculated with logistic regression. The prevalence of oral impacts among people with higher and lower PSS scores was 81.6% and 65.5%, respectively (p < 0.01). Social support was found to have no interactions with stress levels and discrimination. The association between social discrimination and OHRQoL (OIDP score > 0) was OR = 2.03 (95%CI: 1.23; 3.34) among people with a low level of stress, but was OR = 12.6 (95%CI: 1.31; 120.9) among those with higher levels (p = 0.09, for interaction). Individuals who reported experiencing higher levels of psychological stress and discrimination had worse OHRQoL; a synergistic effect with social support was not clear.

El estrés y la discriminación afectan negativamente a la calidad de vida, pero el apoyo social puede mitigar sus efectos. Los objetivos de este estudio son: (1) examinar las asociaciones entre el estrés psicológico, la discriminación y la calidad de vida relacionada con la salud bucal (CVRSB); y (2) evaluar si el apoyo social, el estrés y la discriminación interactúan para modificar sus asociaciones con la CVRSB. Los datos provienen de una encuesta transversal de hogares cuyo estudio incluyó a 396 individuos de 14 años o más de familias registradas en beneficios del gobierno en una ciudad del Sur de Brasil. La CVRSB se midió mediante el Impactos Orales en el Rendimiento Diario (OIDP), mientras que el estrés psicológico se evaluó mediante la Escala de Estrés Percibido (PSS). El apoyo social se basó en el número de familiares o amigos cercanos, y la discriminación en la Escala de Discriminación Cotidiana (EDS). Las interacciones se estimaron mediante el excesivo de riesgo relativo debido a la interacción (RERI). Los efectos ajustados se calcularon mediante regresión logística. La prevalencia de impactos orales entre las personas con puntajes de PSS más altas y más bajas fue del 81,6% y del 65,5%, respectivamente (p < 0,01). El apoyo social presenta interacciones inclusivas con niveles de estrés y discriminación. La asociación entre discriminación social y OHRQoL (puntuación OIDP > 0) fue OR = 2,03 (IC95%: 1,23; 3,34) entre personas con un nivel bajo de estrés, pero fue OR = 12,6 (IC95%: 1,31; 120,9) entre aquellos con niveles más altos (p = 0,09, para interacción). Las personas que informaron tener niveles más elevados de estrés psicológico y discriminación tuvieron una peor CVRSB; el efecto sinérgico con el apoyo social no estaba claro.

ABSTRACT Objective: To assess early-onset sepsis as a risk factor of peri-intraventricular hemorrhage in premature infants born at less than or equal to 34 weeks’ gestation and admitted to a neonatal intensive care unit (NICU). Methods: This retrospective cohort study included premature patients born at less than or equal to 34 weeks’ gestation who were admitted to the NICU of a tertiary hospital in southern Brazil, and born from January 2017 to July 2021. Data were collected from patients’ medical records. Early-onset sepsis was measured according to the presence or absence of diagnosis within the first 72 hours of life, whereas the outcome, peri-intraventricular hemorrhage, was described as the presence or absence of hemorrhage, regardless of its grade. Results: Hazard ratios were calculated using Cox regression models. A total of 487 patients were included in the study, of which 169 (34.7%) had some degree of peri-intraventricular hemorrhage. Early-onset sepsis was present in 41.6% of the cases of peri-intraventricular hemorrhage, which revealed a significant association between these variables, with increased risk of the outcome in the presence of sepsis. In the final multivariate model, the hazard ratio for early-onset sepsis was 1.52 (95% confidence interval 1.01–2.27). Conclusion: Early-onset sepsis and the use of surfactants showed to increase the occurrence of the outcome in premature children born at less than or equal to 34 weeks’ gestation. Meanwhile, factors such as antenatal corticosteroids and gestational age closer to 34 weeks’ gestations were found to reduce the risk of peri-intraventricular hemorrhage.

RESUMO Objetivo: O objetivo do presente trabalho foi avaliar a sepse precoce como fator de risco para hemorragia peri-intraventricular (HPIV) em prematuros com 34 semanas ou menos, admitidos em Unidade de Terapia Intensiva (UTI) Neonatal. Métodos: Este estudo de coorte retrospectivo incluiu pacientes prematuros com 34 semanas ou menos, que receberam alta da UTI Neonatal de hospital terciário, no sul do Brasil, nascidos no período de janeiro de 2017 a julho de 2021. Os dados foram coletados por meio dos prontuários desses pacientes. A sepse precoce foi mensurada conforme a presença ou a ausência do diagnóstico nas primeiras 72 horas de vida. Já o desfecho, hemorragia peri-intraventricular, foi descrito conforme a presença ou ausência da hemorragia, independentemente do grau. Resultados: Hazard ratios (HR) foram calculados por meio de modelos de regressão de Cox. Foram incluídos no estudo 487 pacientes. Destes, 169 (34,7%) apresentaram algum grau de hemorragia peri-intraventricular. A sepse precoce esteve presente em 41,6% dos casos de hemorragia peri-intraventricular e apresentou associação significativa, elevando o risco do desfecho quando presente. No modelo multivariável final, o HR para a sepse precoce foi de 1,52 (intervalo de confiança de 95% — IC95% 1,01–2,27). Conclusão: Sepse precoce e uso de surfactante demonstraram aumentar a ocorrência do desfecho em crianças prematuras até 34 semanas, enquanto fatores como corticoide antenatal e idades gestacionais mais próximas a 34 semanas mostraram reduzir o risco de ocorrência hemorragia peri-intraventricular.

Abstract The scope of this study was to analyze the factors associated with the use of dental services in Brazil. The review strategy included PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS and Google Scholar databases, in addition to repositories and databases of dissertations and theses. Studies were selected using the PEO (Population/Exposure/Outcomes) strategy. The outcome of this study was the use of dental services in the last year by the Brazilian population, treated as dichotomous variables for the following analyses: ≤ 1 year and > 1 year. Mantel-Haenszel random effect meta-analysis was performed, estimating Prevalence Ratios (PR) and 95% confidence intervals (95%CI). A total of 94 studies were selected. The majority (98%) had a cross-sectional design, with 63% derived from primary data. For the meta-analysis, 25 studies were included. The use of oral health services in the last year was associated with higher education (≥ 8 years of schooling) (PR = 0.49, (95%CI: 0.39-0.60)); higher family income (≥ 2 minimum wages) (RP = 0.79, (95%CI: 0.74-0.84)); and living in urban areas (RP = 0.79, (95%CI: 0.64-0.97)). The availability of dental services in the Unified Health System needs to be made readily accessible to people with lower income, less education and those living in rural areas.

Resumo O objetivo foi analisar os fatores associados ao uso dos serviços odontológicos no Brasil. A estratégia de revisão incluiu as bases PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS e Google Scholar, além de repositórios e bancos de dissertações e teses. Os estudos foram selecionados usando a estratégia PEO (população/exposição/desfechos). O desfecho deste estudo foi o uso dos serviços odontológicos no último ano pela população brasileira, tratado como variáveis dicotômicas para as análises: ≤ 1 ano e > 1 ano. Foi realizada uma metanálise de efeito randômico de Mantel-Haenszel, estimando-se razões de prevalência (RP) e intervalos de confiança de 95% (IC95%). Foram selecionados 94 estudos. A maioria (98%) tinha delineamento transversal, sendo 63% oriundos de dados primários. Para a metanálise, 25 estudos foram incluídos. O uso dos serviços odontológicos no último ano esteve associado com maior escolaridade (≥ 8 anos de estudo) (RP = 0,49, (IC95%: 0,39-0,60)); maior renda familiar (≥ 2 salários-mínimos) (RP = 0,79, (IC95%: 0,74-0,84)); e residir na zona urbana (RP = 0,79, (IC95%: 0,64-0,97)). A oferta de serviços odontológicos no Sistema Único de Saúde precisa ser ampliada entre pessoas com menor renda, menor escolaridade e moradores da zona rural.

Abstract This study aimed to investigate the association between serum vitamin D levels and untreated caries and determining factors in children and youth. Methodology: This cross-sectional study used data from the National Health and Nutrition Examination Survey (2013-2014). In total, 3,072 participants with ages ranging from 1 to 19 years were included in our sample. The main dependent variable, untreated caries, was defined as having at least one untreated carious surface in any tooth. Serum concentration of 25-hydroxyvitamin D [25(OH)D] was categorized into four groups: ≥75 nmol/ml, 50-74.9 nmol/ml, 25-49.9 nmol/ml, and <25 nmol/ml. Data were analyzed using a binary logistic regression. Results: For children aged 1-5 years, age (OR = 1.68, 95% confidence intervals (95% CI) 1.38-2.04) and low levels of vitamin D (25-49.9 nmol/ml, and <25 nmol/ml: OR = 2.55, 95% CI 1.06-6.13) were associated with untreated caries. For children aged 6-11 years, low levels of vitamin D (50-74.9 nmol/ml: OR=1.45, 95% CI 1.16-1.82) remained associated with untreated caries. No associations were found in those between 12 and 19 years of age. Conclusion: Our findings show an association between low levels of 25(OH)D and untreated caries in children between 1 and 11 years of age, suggesting that this nutrient might interfere in the caries process.

Resumo Este estudo teve como objetivo investigar a associação entre os níveis séricos de vitamina D e cárie dentária não-tratada e fatores determinantes em crianças e jovens. Metodologia: Este estudo transversal utilizou dados da Pesquisa Nacional de Saúde e Nutrição (2013-2014). No total, 3.072 participantes com idades entre 1 e 19 anos foram incluídos em nossa amostra. A principal variável dependente, cárie não-tratada, foi definida como pelo menos uma superfície de cárie não-tratada em qualquer dente. A concentração sérica de 25-hidroxivitamina D [25(OH)D] foi categorizada em quatro grupos: ≥75 nmol/ml, 50-74,9 nmol/ml, 25-49,9 nmol/ml e <25 nmol/ml. Os dados foram analisados por meio de regressão logística binária. Resultados: Para crianças de 1 a 5 anos, idade (OR = 1,68, intervalo de confiança de 95% (IC 95%) 1,38 a 2,04) e baixos níveis de vitamina D (25 a 49,9 nmol/ml e <25 nmol/ml: OR = 2,55, IC 95% 1,06-6,13) foram associados a cárie não-tratada. Para crianças de 6 a 11 anos, baixos níveis de vitamina D (50 a 74,9 nmol/ml: OR = 1,45, IC 95% 1,16 a 1,82) permaneceram associados à cárie não-tratada. Não foram encontradas associações naqueles entre 12 e 19 anos de idade. Conclusão: Nossos achados mostram uma associação entre baixos níveis de 25(OH)D e cárie não-tratada em crianças de 1 a 11 anos, sugerindo que este nutriente pode interferir no processo da cárie dentária .

Resumo O objetivo foi analisar os fatores associados ao uso dos serviços odontológicos no Brasil. A estratégia de revisão incluiu as bases PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS e Google Scholar, além de repositórios e bancos de dissertações e teses. Os estudos foram selecionados usando a estratégia PEO (população/exposição/desfechos). O desfecho deste estudo foi o uso dos serviços odontológicos no último ano pela população brasileira, tratado como variáveis dicotômicas para as análises: ≤ 1 ano e > 1 ano. Foi realizada uma metanálise de efeito randômico de Mantel-Haenszel, estimando-se razões de prevalência (RP) e intervalos de confiança de 95% (IC95%). Foram selecionados 94 estudos. A maioria (98%) tinha delineamento transversal, sendo 63% oriundos de dados primários. Para a metanálise, 25 estudos foram incluídos. O uso dos serviços odontológicos no último ano esteve associado com maior escolaridade (≥ 8 anos de estudo) (RP = 0,49, (IC95%: 0,39-0,60)); maior renda familiar (≥ 2 salários-mínimos) (RP = 0,79, (IC95%: 0,74-0,84)); e residir na zona urbana (RP = 0,79, (IC95%: 0,64-0,97)). A oferta de serviços odontológicos no Sistema Único de Saúde precisa ser ampliada entre pessoas com menor renda, menor escolaridade e moradores da zona rural.

Abstract The scope of this study was to analyze the factors associated with the use of dental services in Brazil. The review strategy included PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS and Google Scholar databases, in addition to repositories and databases of dissertations and theses. Studies were selected using the PEO (Population/Exposure/Outcomes) strategy. The outcome of this study was the use of dental services in the last year by the Brazilian population, treated as dichotomous variables for the following analyses: ≤ 1 year and > 1 year. Mantel-Haenszel random effect meta-analysis was performed, estimating Prevalence Ratios (PR) and 95% confidence intervals (95%CI). A total of 94 studies were selected. The majority (98%) had a cross-sectional design, with 63% derived from primary data. For the meta-analysis, 25 studies were included. The use of oral health services in the last year was associated with higher education (≥ 8 years of schooling) (PR = 0.49, (95%CI: 0.39-0.60)); higher family income (≥ 2 minimum wages) (RP = 0.79, (95%CI: 0.74-0.84)); and living in urban areas (RP = 0.79, (95%CI: 0.64-0.97)). The availability of dental services in the Unified Health System needs to be made readily accessible to people with lower income, less education and those living in rural areas.

Resumo: No Brasil, houve expansão da cobertura de serviços odontológicos na atenção primária à saúde (APS), e a ênfase do trabalho dos profissionais mudou para incluir mais esforços na prevenção e no diagnóstico. Entretanto, pouco se sabe sobre a influência da cobertura do Programa Bolsa Família no uso desses serviços. Esta pesquisa avaliou a associação entre cobertura municipal do Programa Bolsa Família e uso de serviços odontológicos. Este estudo ecológico, realizado com dados dos 5.570 municípios brasileiros, estimou, por meio de regressões logísticas, o impacto da variação de cobertura do Programa Bolsa Família, das Estratégias Saúde da Família (ESF) e das equipes de saúde bucal (EqSB) no número de procedimentos odontológicos restauradores, coletivos, preventivos e exodontias realizados via Sistema Único de Saúde (SUS) entre os períodos 2007/2008 e 2010/2011. Os percentuais de municípios em que houve aumento das taxas de procedimentos preventivos, coletivos, restauradores e exodontias foram de 46%, 59,8%, 52,5% e 44,2%, respectivamente. No modelo ajustado, em municípios com maior cobertura do Bolsa Família houve menos chances de aumentar a ocorrência de procedimentos coletivos (OR = 0,91; IC95%: 0,79-1,04) e preventivos (OR = 0,92; IC95%: 0,80-1,05) e mais chances de elevar as taxas de procedimentos restauradores (OR = 1,11; IC95%: 0,97-1,28) e exodontias (OR = 1,10; IC95%: 0,95-1,27). A expansão na taxa de cobertura das EqSB esteve associada significativamente a uma chance maior de aumento do número de procedimentos preventivos, restauradores e exodontias. Conclui-se que a cobertura das EqSB foi a principal variável associada à ampliação da quantidade de procedimentos odontológicos realizados no serviço público.

Resumen: En Brasil, hubo una expansión de la cobertura de servicios odontológicos en la atención primaria a la salud, y el énfasis del trabajo de los profesionales cambió para incluir más esfuerzos en la prevención y en el diagnóstico. Sin embargo, poco se sabe sobre la influencia de la cobertura del Programa Bolsa Familia en el uso de los servicios odontológicos. El presente estudio evaluó la asociación entre la cobertura municipal del Programa Bolsa Familia y uso de servicios odontológicos. Un estudio ecológico realizado con datos de los 5.570 municipios brasileños estimó, a través de regresiones logísticas; el impacto de la variación de cobertura del Programa Bolsa Familia, de las Estrategias de Salud de la Familia (ESF) y de los equipos de salud bucal (EqSB) en el número de procedimientos odontológicos restauradores, colectivos, preventivos y exodoncias realizados a través del Sistema Único de Salud (SUS) entre los períodos 2007/2008 y 2010/2011. El porcentaje de municipios que aumentaron las tasas de procedimientos preventivos, colectivos, restauradores y exodoncias fue del 46 %, 59,8 %, 52,5 % y 44,2 %, respectivamente. En el modelo ajustado, los municipios con aumento de la cobertura de Programa Bolsa Familia tuvieron menos probabilidades de aumentar procedimientos colectivos (OR = 0,91; IC95%: 0,79-1,04), y preventivos (OR = 0,92; IC95%: 0,80-1,05), y más probabilidades de aumentar las tasas de procedimientos restauradores (OR = 1,11; IC95%: 0,97-1,28) y exodoncias (OR = 1,10; IC95%: 0,95-1,27). El aumento en la tasa de cobertura de EqSB se asoció significativamente con una mayor probabilidad de aumento en procedimientos preventivos, restauradores y exodoncias. Se concluye que la cobertura de las EqSB fue la principal variable asociada al aumento de los procedimientos odontológicos realizados en el servicio público.

Abstract: In Brazil, there has been an expansion of the coverage of dental services in primary health care (PHC), and the focus of the services has changed to include more efforts in prevention and diagnosis. However, little is known about the influence of the coverage of the Brazilian Income Transfer program on the use of dental services. Our study evaluates the association between municipal coverage of the Brazilian Income Transfer Program and the use of dental services. This ecological study conducted with data from the 5,570 Brazilian municipalities estimates, via logistic regressions, the impact of the coverage of the Brazilian Income Transfer program, the Family Health Strategies (FHS), and the oral health teams on the number of restoration, colective, prevention, and dental extraction procedures performed by the Brazilian Unified National Health System (SUS) between the periods 2007/2008 and 2010/2011. The percentage of municipalities that increased the rates of prevention, colective, restoration, and extraction procedures was 46%, 59.8%, 52.5%, and 44.2%, respectively. In the adjusted model, municipalities with increased coverage of Brazilian Income Transfer program were less likely to increase colective (OR = 0.91; 95%CI: 0.79-1.04) and prevention (OR = 0.92; 95%CI: 0.80-1.05) procedures, and they were more likely to increase rates of restoration (OR = 1.11; 95%CI: 0.97-1.28) and dental extraction (OR = 1,10; 95%CI: 0.95-1.27) procedures. The increase in the coverage rate of the oral health teams was significantly associated with a higher chance of an increase in prevention, restoration, and extraction procedures. We conclude that the coverage of oral health teams was the main variable associated with the increase in dental procedures performed in the public service.

Abstract This study aimed to evaluate the pathways that explain the association between race/skin color and edentulism in elderly Brazilians. This was a cross-sectional study using data from participants aged 60 years or older from the 2019 Brazilian National Health Survey, a nationally representative population-based sample. Data were obtained by a structured interview and participants were classified as edentulous if they reported having lost all natural teeth. Information on race, socioeconomic level, behavioral aspects, psychosocial aspects, and access to dental care was collected by interviewers using a questionnaire. The pathways between race/skin color and edentulism were analyzed using structural equation modeling. The final sample of the study included 22,357 participants. Most participants were white (51.5%; 95% confidence interval [CI]: 50.3–52.6), and 36.8% (95%CI: 35.7–37.9) were edentulous. Race/skin color was indirectly associated with edentulism via enabling factors. These findings suggest that socioeconomic inequalities are key in explaining racial inequalities in edentulism among Brazilian older adults.

Abstract: In Brazil, there has been an expansion of the coverage of dental services in primary health care (PHC), and the focus of the services has changed to include more efforts in prevention and diagnosis. However, little is known about the influence of the coverage of the Brazilian Income Transfer program on the use of dental services. Our study evaluates the association between municipal coverage of the Brazilian Income Transfer Program and the use of dental services. This ecological study conducted with data from the 5,570 Brazilian municipalities estimates, via logistic regressions, the impact of the coverage of the Brazilian Income Transfer program, the Family Health Strategies (FHS), and the oral health teams on the number of restoration, colective, prevention, and dental extraction procedures performed by the Brazilian Unified National Health System (SUS) between the periods 2007/2008 and 2010/2011. The percentage of municipalities that increased the rates of prevention, colective, restoration, and extraction procedures was 46%, 59.8%, 52.5%, and 44.2%, respectively. In the adjusted model, municipalities with increased coverage of Brazilian Income Transfer program were less likely to increase colective (OR = 0.91; 95%CI: 0.79-1.04) and prevention (OR = 0.92; 95%CI: 0.80-1.05) procedures, and they were more likely to increase rates of restoration (OR = 1.11; 95%CI: 0.97-1.28) and dental extraction (OR = 1,10; 95%CI: 0.95-1.27) procedures. The increase in the coverage rate of the oral health teams was significantly associated with a higher chance of an increase in prevention, restoration, and extraction procedures. We conclude that the coverage of oral health teams was the main variable associated with the increase in dental procedures performed in the public service.

Resumen: En Brasil, hubo una expansión de la cobertura de servicios odontológicos en la atención primaria a la salud, y el énfasis del trabajo de los profesionales cambió para incluir más esfuerzos en la prevención y en el diagnóstico. Sin embargo, poco se sabe sobre la influencia de la cobertura del Programa Bolsa Familia en el uso de los servicios odontológicos. El presente estudio evaluó la asociación entre la cobertura municipal del Programa Bolsa Familia y uso de servicios odontológicos. Un estudio ecológico realizado con datos de los 5.570 municipios brasileños estimó, a través de regresiones logísticas; el impacto de la variación de cobertura del Programa Bolsa Familia, de las Estrategias de Salud de la Familia (ESF) y de los equipos de salud bucal (EqSB) en el número de procedimientos odontológicos restauradores, colectivos, preventivos y exodoncias realizados a través del Sistema Único de Salud (SUS) entre los períodos 2007/2008 y 2010/2011. El porcentaje de municipios que aumentaron las tasas de procedimientos preventivos, colectivos, restauradores y exodoncias fue del 46 %, 59,8 %, 52,5 % y 44,2 %, respectivamente. En el modelo ajustado, los municipios con aumento de la cobertura de Programa Bolsa Familia tuvieron menos probabilidades de aumentar procedimientos colectivos (OR = 0,91; IC95%: 0,79-1,04), y preventivos (OR = 0,92; IC95%: 0,80-1,05), y más probabilidades de aumentar las tasas de procedimientos restauradores (OR = 1,11; IC95%: 0,97-1,28) y exodoncias (OR = 1,10; IC95%: 0,95-1,27). El aumento en la tasa de cobertura de EqSB se asoció significativamente con una mayor probabilidad de aumento en procedimientos preventivos, restauradores y exodoncias. Se concluye que la cobertura de las EqSB fue la principal variable asociada al aumento de los procedimientos odontológicos realizados en el servicio público.

Resumo: No Brasil, houve expansão da cobertura de serviços odontológicos na atenção primária à saúde (APS), e a ênfase do trabalho dos profissionais mudou para incluir mais esforços na prevenção e no diagnóstico. Entretanto, pouco se sabe sobre a influência da cobertura do Programa Bolsa Família no uso desses serviços. Esta pesquisa avaliou a associação entre cobertura municipal do Programa Bolsa Família e uso de serviços odontológicos. Este estudo ecológico, realizado com dados dos 5.570 municípios brasileiros, estimou, por meio de regressões logísticas, o impacto da variação de cobertura do Programa Bolsa Família, das Estratégias Saúde da Família (ESF) e das equipes de saúde bucal (EqSB) no número de procedimentos odontológicos restauradores, coletivos, preventivos e exodontias realizados via Sistema Único de Saúde (SUS) entre os períodos 2007/2008 e 2010/2011. Os percentuais de municípios em que houve aumento das taxas de procedimentos preventivos, coletivos, restauradores e exodontias foram de 46%, 59,8%, 52,5% e 44,2%, respectivamente. No modelo ajustado, em municípios com maior cobertura do Bolsa Família houve menos chances de aumentar a ocorrência de procedimentos coletivos (OR = 0,91; IC95%: 0,79-1,04) e preventivos (OR = 0,92; IC95%: 0,80-1,05) e mais chances de elevar as taxas de procedimentos restauradores (OR = 1,11; IC95%: 0,97-1,28) e exodontias (OR = 1,10; IC95%: 0,95-1,27). A expansão na taxa de cobertura das EqSB esteve associada significativamente a uma chance maior de aumento do número de procedimentos preventivos, restauradores e exodontias. Conclui-se que a cobertura das EqSB foi a principal variável associada à ampliação da quantidade de procedimentos odontológicos realizados no serviço público.

Abstract INTRODUCTION Epidemiological surveys revealed that Brazil has a high burden of oral diseases. However, no prior study has reported estimates of untreated dental caries, periodontitis, and edentulism over a three-decade period. The objective of this study is to report the trends of prevalence, incidence, and years-lived with disability (YLDs) due to untreated dental caries in primary and permanent teeth, periodontitis, and edentulism in Brazil between 1990 and 2019. METHODS Estimates of prevalence, incidence, and YLDs due to dental caries in primary and permanent teeth, periodontitis, and edentulism were produced for Brazil, by sex and age, between 1990 and 2019, using Dismod-MR 2.1, as part of the Global Burden of Disease Study 2019 (GBD 2019). Trends of oral disorders were analyzed using generalized linear regression models applying the Prais-Winsten method. RESULTS Almost 100 million Brazilians presented at least one oral disorder in 2019, which was equivalent to a prevalence of 45.3%. All oral diseases combined ranked eighth among all causes of disability, causing more than 970,000 YLDs. Untreated dental caries in primary teeth were estimated to affect 13.5 million children, and untreated dental caries in permanent teeth affected more than 52 million people. Periodontitis affected 29.5 million people, and edentulism affected almost 22 million. The generalized linear regression models revealed a trend of stability of oral disorders between 1990 and 2019. CONCLUSIONS The burden of oral diseases in Brazil is extremely high. Oral disorders, edentulism in particular, caused disability at levels that are comparable to other important chronic diseases.

RESUMO Objetivo avaliar a prevalência de maloclusões e seus fatores associados em crianças atendidas em um Serviço de APS de Porto Alegre, Brasil. Método estudo transversal aninhado a uma coorte, realizado em 12 Unidades de Saúde. Das 414 crianças da coorte examinadas, 268 foram examinadas para maloclusão. A presença de mordida aberta anterior, mordida cruzada posterior e anterior foi avaliada pelos critérios de Foster e Hamilton. Variáveis socioeconômicas, hábitos de amamentação e informações sobre o uso de chupeta foram coletados por meio de questionário padronizado. A análise dos dados foi realizada por meio de uma abordagem hierárquica por Regressão de Poisson com variância robusta. Resultados do total de 268 avaliados, 135 (50,4%) eram meninos e a média de idade foi de 28,6 (± 11,9) meses. Dos 143 (53,4%) casos de maloclusão, 113 eram mordida aberta anterior, 16 eram mordida cruzada anterior, 27 eram mordida cruzada posterior e 38 tinham overjet acentuado. Na análise final, observou-se que houve maior prevalência de maloclusões em crianças que nunca foram amamentadas (RP = 1,44; IC95% 1,00-2,08) e que sempre usaram chupeta para dormir (RP = 1,81; IC95% 1,14 -2,86). Conclusão a prevalência de maloclusões nesta população foi elevada e esteve associada a hábitos comportamentais, como o uso de chupeta e a não amamentação.

ABSTRACT Purpose to evaluate the prevalence of malocclusion and its associated factors of children cared for by a PHC Service in Porto Alegre, Brazil. Methods a cross-sectional study nested in a cohort, carried out in 12 Health Care Practices. Of the 414 children in the cohort examined, 268 were assessed for malocclusion. The presence of anterior open bite, posterior and anterior crossbite was evaluated by the criteria of Foster and Hamilton. Socioeconomic variables, breastfeeding habits and pacifier use information were collected through a standardized questionnaire. Data analysis was performed using a hierarchical approach by Poisson Regression with robust variance. Results out of the total 268 evaluated, 135 (50.4%) were boys, and the average age was 28.6 (± 11.9) months. Out of the 143 (53.4%) cases of malocclusion, 113 were anterior open bite, 16 were anterior crossbite, 27 were posterior crossbite, and 38 had increased overjet. In the final analysis, it was observed that there was a higher prevalence of malocclusion in children who never breastfed (PR = 1.44; 95%CI 1.00-2.08) and who always used a pacifier to sleep (PR = 1.81; 95%CI 1.14-2.86). Conclusion the prevalence of malocclusion in this population was high and was associated with behavioral habits, such as the use of pacifier and not breastfeeding.

Abstract Although there is a large body of evidence of the influence of social determinants on oral health, information on the mechanisms by which these determinants operate is poorly documented. Therefore, we aimed to investigate the pathways through which socioeconomic inequalities may influence self-perceived oral health (SPOH) in Brazilian adults. This cross-sectional study used data from the National Health Survey (NHS) of 2019, with a representative sample of adults aged 18 to 59 years (n = 65,803). The outcome was SPOH, assessed by a global self-item. Structural equation modeling was used to test direct and indirect pathways connecting a latent variable for socioeconomic position (SEP) to SPOH via psychosocial, behavioral, and biological factors. Higher SEP was directly associated with better SPOH [standardized coefficient (SC) = 0.069; p < 0.01)] fewer depressive symptoms (SC = -0.059; p < 0.01), fewer missing teeth (SC = 0.131; p < 0.01), and more healthy behaviors (SC = 0.643; p < 0.01). Fewer depressive symptoms (SC = -0.141; p < 0.01), more healthy behaviors (SC = 0.242; p < 0.01), and fewer missing teeth (SC = 0.058; p < 0.01) were directly associated with good SPOH. Among specific indirect effects of SEP on SPOH, the behavioral pathway was the one that best explained this association (SC = 0.155). Socioeconomic inequities in SPOH are mediate by psychosocial, behavioral, and biological factors. This has implications for positioning health strategies in the social context in which people live, to facilitate healthy choices and promote good oral health.

Abstract The aim of this study was to describe the occurrence of dental emergency and its association with individual factors and primary health care services. A follow-up study was conducted with data extracted from an exploratory study about the classification of dental care needs over time according to a care framework. There were included 1831 patients of five services. The outcome was the occurrence of dental emergency analyzed according to sex, age, skin color, service and maximum waiting time for dental care. A multivariate analysis with Poisson regression was used to estimate weighted prevalence ratio (PR) with 95% Confidence Intervals (CI) and survival analysis was conducted. The prevalence of dental emergency was 12.6%, varying according to age (13–19: PRa =1.79 (95%CI: 1.0–3.21); 20–65:PRa = 2.71 (95%CI: 1.73–4.26); Over 65: PRa = 2.51 (95%CI: 1.41–4.46)) and Primary Health Care service (FHS 2: PRa = 2.20 (95%CI: 1.37–3.53),FHS 3: PRa = 1.43 (95%CI: 0.90–2.27); FHS 4: PRa = 3.25 (95%CI: 2.15–4.92),FHS 5: PRa = 2.49 (95%CI: 1.56–3.97)) For 231 cases classified as emergency, the failure rate was 7.4%. For 214 cases of emergency, the non-continuity after appointment rate was 53.7%. The incidence of dental emergency was 8.3% and recurrence was 7.2%. Considering all 262 emergency cases attended, the resolution rate was 93.5% and most cases (n = 252, 96.1%) received care within one day. The results point to high effectiveness in emergency dental care within Primary Health Care services. There are indications of the need for improvements in retention and continuity of care.

Abstract Determinants of oral diseases include behaviors, which in turn are influenced by a series of social determinants such as psychosocial aspects and dental care services. Therefore, the aim of this study was to investigate whether depressive symptoms and use of dental care services mediate the relationship between socioeconomic status (SES) and oral health behaviors. This was a cross-sectional study that analyzed data from participants in the 2019 National Health Survey (PNS) (n = 88,531). The eligibility criteria were individuals who were 18 years and older and exclusion criterion was living in households located in special or sparsely populated census tracts. Structural equation modeling (SEM) was used to test direct and indirect pathways from a latent variable for SES to oral health through depressive symptoms (assessed through the “Patient Health Questionnaire-9”) and use of dental care services. The maximum likelihood estimator for complex samples with the robust standard error was used. The final model presented an adequate fit: RMESA of 0.008, CFI of 0.998, and SMRM of 0.005. The results showed that higher SES was directly associated with better oral health-related behaviors [standardized coefficient (SC): 0.428; p < 0.01] and indirectly through depressive symptoms [(SC): 0.002; p < 0.01] and dental care services [(SC): 0.089; p < 0.01]. The total effect of SES on oral health-related behaviors was equal to [(SC: 0.519 (p < 0.01)]. In conclusion, the findings suggest that high socioeconomic status, mediated by depressive symptoms and dental care services, has a positive effect on oral health.

Resumo Nas últimas duas décadas, observou-se um interesse crescente nos estudos de hipomineralização molar-incisivo (HMI). Os defeitos hipomineralizados podem ter várias consequências, como hipersensibilidade, aumento do acúmulo de placa dentária e, consequentemente, maior risco de cárie. Este estudo transversal teve como objetivo investigar a prevalência de HMI e sua associação com cárie dentária em escolares de um município do sul do Brasil. Uma amostra aleatória de alunos por conglomerado foi selecionada. Os exames clínicos foram realizados para coletar informações sobre HMI (seguindo os critérios da European Academy of Pediatric Dentistry), cárie dentária (usando o índice DMF-T) e gengivite. Variáveis socioeconômicas, demográficas e comportamentais foram coletadas por meio de um questionário padronizado respondido pelos pais / responsáveis pelas crianças. Razões de prevalência (RP) foram estimadas por meio de análise de regressão de Poisson com variância robusta por meio de abordagem hierárquica (p <0,05). Um total de 513 escolares foram incluídos no estudo. A prevalência de MIH e cárie foi de 19,7% e 31,6%, respectivamente. A média de idade foi de 11,6 (± 1,9) anos. A cárie dentária foi mais prevalente em crianças com HMI (RP 1,39; IC 95% 1,05 - 1,85). Crianças mais velhas e crianças cujas famílias estavam matriculadas em programas de transferência condicional de renda (RP 1,97 IC95% 1,47 - 2,64), e crianças que não tinham a mãe ou o pai como chefe da família (RP 1,56 IC95% 1,06 - 2,30) apresentaram maior prevalência de cárie dentária. Nossos resultados sugerem que crianças com HMI são mais propensas a ter cárie dentária.

Abstract The last couple of decades has seen an increasing interest in molar-incisor hypomineralization (MIH) studies. Hypomineralized defects can have several consequences such as hypersensitivity, increased dental plaque accumulation, and consequently higher caries risk. This cross-sectional study aimed to investigate the prevalence of MIH and its association with dental caries in schoolchildren from a city in southern Brazil. A random cluster sample of schoolchildren was selected. Clinical examinations were carried out to collect information on MIH (following the European Academy of Pediatric Dentistry criteria), dental caries (using the DMF-T index) and gingivitis. Socioeconomic, demographic and behavior variables were collected using a standardized questionnaire answered by the children’s parents/caregivers. Prevalence ratios (PR) were estimated using Poisson regression analysis with robust variance through a hierarchical approach (p<0.05). A total of 513 schoolchildren were included in the study. MIH and caries prevalence was 19.7% and 31.6%, respectively. The mean age was 11.6 (+1.9) years. Dental caries was more prevalent in children with MIH (PR 1.39; 95% CI 1.05 - 1.85). Older children and children whose families were enrolled in conditional cash transference programs (PR 1.97 95% CI 1.47 - 2.64), and children who did not have their mother or father as the head of the family (PR 1.56 95% CI 1.06 - 2.30) presented a higher prevalence of dental caries. Our findings suggest that children with MIH are more likely to have dental caries.

RESUMO Objetivo Verificar os fatores anatomofisiológicos, psicológicos, socioculturais do binômio mãe neonato e sua associação com o início da prática do aleitamento materno. Método Estudo transversal realizado em uma Maternidade de Lima Peru. A amostra foi de 304 neonatos sadios e suas respectivas mães. O desempenho na amamentação foi estimado por avaliação clínica utilizando-se a escala de Avaliação Clínica da Eficácia da Amamentação e a autopercepção materna pela Escala de Autoeficácia da Amamentação. Razões de Prevalência (RP) multivariadas foram estimadas pela Regressão de Poisson com Variância Robusta e intervalos de confiança (IC) de 95%. Resultados A prevalência de baixo desempenho clínico na amamentação foi de 27,6%. Primíparas associarem-se a maior prevalência de baixo desempenho quando não confiavam em ter sucesso [RP:2,02(IC95%:1,18-3,44)] e menor prevalência em ter boa pega [RP:0,52(IC95%:0,29-0,95)], assim como em enfrentar com êxito [RP:0,59(IC95%:0,37-0,91)]. As multíparas, apresentaram maior prevalência quando não confiavam em manter-se motivadas [RP:3,47(IC95%:1,67-7,22)] e em acalmar o neonato [RP:4,07(IC95%:1,83-9,95)]. Houve menor prevalência em manter o neonato acordado [RP:0,32(IC95%:0,14-0,75)] e quando não se sentiam confiantes na presença de seus familiares [RP:0,29(IC95%:0,13-0,64)]. Conclusão É importante que profissionais da saúde estejam atentos às questões emocionais, sociais e culturais para a promoção de um aleitamento materno com qualidade.

ABSTRACT Purpose To verify the anatomophysiological, psychological, and sociocultural factors of the mother-newborn binomial, as well as their association with the initiation of breastfeeding. Methods Cross-sectional study conducted in a maternity hospital in Lima, Peru. The sample consisted of 304 healthy neonates and their mothers. Breastfeeding performance was estimated by clinical assessment using the Clinical Evaluation of Breastfeeding Efficacy scale and maternal self-perception by the Breastfeeding Self-Efficacy Scale. Multivariate Prevalence Ratios (PR) were estimated by Poisson Regression with Robust Variance and 95% confidence intervals (CI). Results The prevalence of clinical low breastfeeding performance was 27.6%. Primiparous women were associated with higher prevalence of low performance when they did not trust to succeed [PR:2.02(95%CI:1.18-3.44)] and lower prevalence in having a good latch [PR:0.52(95%CI:0.29-0.95)], as well as in coping successfully [PR:0.59(95%CI:0.37-0.91)]. Multiparous women showed higher prevalence when they were not confident in staying motivated [PR:3.47(95%CI:1.67-7.22)] and in calming the neonate [PR:4.07(95%CI:1.83-9.95)]. There was lower prevalence in keeping the neonate awake [PR:0.32(95%CI:0.14-0.75)] and when they did not feel confident in the presence of their family [PR:0.29(95%CI:0.13-0.64)]. Conclusion It is important that health professionals be aware of emotional, social, and cultural issues to promote quality breastfeeding.