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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.

Abstract The aim of this study was to develop and achieve consensus on a cariology teaching framework for dental schools in Latin American Spanish-speaking countries. The Delphi process, with a ≥8 0% pre-defined participants’ agreement, included three phases and a Coordinating Group. During the Preparation phase three panels of experts were selected and invited to participate: a) Regional academic/professional Dental Associations (Associations-Panel): n = 12; b) Regional Dental Schools (Dental-Schools-Panel): existing dental schools (n = 263) from the 19 Spanish-speaking regional countries; c) International academic/professional associations Peer Experts (Peer-Panel): n = 4. Based on consensus documents from Europe, Colombia, the Caribbean, USA, Chile and Spain, and updated scientific evidence, the Coordinating Group developed a baseline framework proposal of domains, main competencies (MC) and specific competencies (SC). The Consultation-Agreement and Consensus phases included three rounds of questionnaires with a step-wise sharing of the MC updated version of the consensus framework with the Dental-Schools-Panel and including SC with the Associations-Panel. Diverse communication strategies were used ( e.g ., independent google-form questionnaires and workshops). Consensus was reached after an on-site Associations-Panel workshop and secret voting, followed by an online meeting with the Peers-Panel. A total of 127 academic/professional institutions participated (Associations-Panel: 11, 91.6%; Dental-Schools-Panel: 112, 42.6%, all countries; Peers-Panel: 4, 100%). The baseline Cariology teaching framework of 5 domains, 10 MC and 92 SC underwent modifications after agreements for a final consensus framework consisting of 5 domains, 10 MC and 85 SC. A Core Cariology curriculum framework in Spanish for Latin American Dental Schools was successfully developed and agreed upon with regional dental academic and professional institutions.

Objective: Prior epidemiological surveys revealed that Chile experiences 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 for the country. Using estimates of the Global Burden of Diseases Study (GBD) 2019, the objective of this study is to report the trends of prevalence, incidence, and years-lived with disability (YLDs) due to untreated dental caries, periodontitis, and edentulism in Chilean older adults between 1990 and 2019. Methods: Estimates of prevalence, incidence, and YLDs due to dental caries, periodontitis, and edentulism were produced for Chile, by age and sex, between 1990 and 2019, using Dismod-MR 2.1. Trends of oral disorders were analyzed using generalized linear regression models applying the Prais-Winsten method. Results: Untreated dental caries and periodontal disease showed an increase in prevalence and YLDs, whereas edentulism prevalence, incidence, and YLDs decreased in all older adults age groups. The incidence of dental caries decreased in the younger groups and increased in the older age groups; while the incidence of periodontal disease increased in the younger and decreased in the older age groups. Conclusions: Overall, the burden of oral diseases in older Chileans increased between 1990 and 2019. This was particularly relevant for untreated caries and periodontal disease. Future estimates of oral diseases burden in Chile require concerted efforts to produce national health surveys that incorporate oral diseases metrics. These estimates are essential to inform policy formulation, implementation and evaluation.

Abstract The aim of this study was to develop a virtual learning object (VLO) to teach undergraduate dental students about the diagnostic and therapeutic approaches to oral ulcerative lesions. The VLO was developed with information on the diagnostic process, lesion classification, and clinical-surgical management of oral ulcerative lesions. The VLO content was initially validated by a group of specialists. Learning was evaluated in a sample of 58 undergraduate dental students, divided into control group (conventional theoretical class, n = 29) and intervention group (interaction with VLO, n = 29). All students answered a pre-test and post-test questionnaire. The VLO group also answered a specific questionnaire on the evaluation of the VLO. Both quantitative and qualitative descriptive analyses were performed. The validation showed that professors and students considered the VLO adequate. The use of the VLO was recommended by 100% of professors and 86.6% of students. In the intervention group, the results showed a significantly higher number of correct answers in the post-test (p < 0.01). In conclusion, the VLO proved to be a useful tool for teaching oral medicine, contributing significantly to the knowledge of ulcerated lesions in the mouth.

Abstract The present study aimed to evaluate the association of genital and oral HPV infection among different sexual practices in both sexes. In total, 6388 unvaccinated men and women aged 16–25 years from all state capitals of Brazil were enrolled in through primary care services between September 2016 and November 2017. Genital and oral HPV genotyping was performed using the Roche Linear Array. Poisson regression analysis with robust variance was conducted to examine factors associated with overall HPV infection. A higher prevalence of genital HPV was found in women who practiced oral sex (57.85%) and in men who practiced all types of sex (65.87%). However, having more sexual partners and being younger were more important than the type of sex practiced. HPV 6 (7.1%) and 16 (10.5%) were significantly more prevalent in women who practiced oral sex, while HPV 6 (23.96%) and 11 (21.49%) were more prevalent in men who practiced anal sex. The type of sex was not associated with oral HPV prevalence. Genital and oral HPV infection were not associated by different sexual practices in the studied population.

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 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.

Abstract Less-than-optimal reliability of mortality information systems regarding the underlying cause of death can mask the reality of oral (OC) and oropharyngeal cancer (OPC) mortality. This study aimed to assess the impact on the magnitude and temporal trends of OC and OPC mortality in Brazil of two statistical approaches to redistribute deaths with ill-defined underlying causes. We analyzed deaths with ill-defined causes in Brazil by macro-region, between 1996-2018. The Mortality Information System provided official information on deaths. Two correction methods were applied: the EF method, which proportionally reallocates deaths classified as R00-R99 in the ICD-10 to the remaining specific causes of death according to the proportion of deaths with certified causes; and the GBD method, which considers the concept of garbage codes, redistributing deaths from several ICD-10 chapters according to previously established coefficients. For the trend analysis of mortality (certified and redistributed), the Prais-Winsten method was carried out. The OC and OPC death rates had an evident increase after the redistribution by the two techniques in all regions of the country; the increase was higher using the GBD method. In the Northeast and North regions, this method more than doubled the certified death rates. The redistribution methods also changed time series trends. In epidemiological studies of mortality from OC and OPC, it is necessary to redistribute deaths from ill-defined causes when analyzing data from less-than-optimal information systems. The choice of the correction method is critical; epidemiological studies must manage it as a methodological decision that has significant impacts on results.

Introducción: Debido a su alta incidencia y elevada tasa de mortalidad, el cáncer de cabeza y cuello es considerado un problema de salud en muchos países. En Uruguay, en el periodo 2004- 2008 la tasa de mortalidad por cáncer oral y faríngeo fue 6,46 en hombres y 1, 16 en mujeres. Objetivos: Analizar las tendencias de mortalidad por cáncer oral y orofaríngeo en Uruguay durante el período 1997-2014 y correlacionar con edad, sexo, sitio anatómico del tumor y distribución geográfica. Materiales y métodos: Estudio ecológico de series temporales con datos secundarios. Los datos de mortalidad por cáncer oral y orofaríngeo fueron obtenidos en el Departamento de Estadísticas Vitales del Ministerio de Salud Pública de Uruguay y los datos sociodemográficos del Instituto de Estadísticas del Uruguay (año 2011). Fueron incluidas todas las neoplasias categorizadas de C00 a C10 en la 10a Revisión de la Clasificación Internacional de Enfermedades. Las tasas de mortalidad fueron estandarizadas x 100.000 habitantes, por sexo y por edad por el método directo, tomando con referencia la población uruguaya en el año 2011. Resultados: Entre 1997 y 2014 hubo 1696 muertes por cáncer oral y orofaríngeo en Uruguay. La relación entre hombres y mujeres fue de 3.23:1 siendo la proporción más baja en neoplasias de glándulas salivales y la más alta en la región de orofaringe. Las tasas de mortalidad se han mantenido estables a lo largo de los años en cada sitio anatómico. La tasa de mortalidad en los hombres fue, en promedio, 4,70 veces mayor que en las mujeres, solo fue mayor para las mujeres en los tumores de las glándulas salivales, excepto la parótida. En los diferentes grupos de edad, la tasa fue 4,84 veces mayor en hombres que en mujeres. Se observó la mortalidad está disminuyendo en los departamentos de Artigas y Rivera, manteniéndose estable en los demás departamentos. Conclusión: La mortalidad por cáncer oral y orofaríngeo en Uruguay ha permanecido estable durante el período 1997-2014.

Abstract Background Among the methods currently available to provide fluoride in population levels, fluoridated water is the most successful for presenting high efficacy, safety and good cost–benefit. However, recent studies on external control have shown great variability of fluoride concentrations in the water from treatment stations in Brazilian cities, which must present concentration between 0.6 and 0.8 mg/L to be considered acceptable in most cities. Thus, this study aimed to perform a systematic review of the literature to assess the adequacy of fluoride concentration in the water in Brazilian cities using external control. Methods The protocol was registered in PROSPERO. Six databases were used as primary search sources and three databases were used to partially capture the "gray literature". Only observational studies that assessed the fluoride concentration of artificially fluoridated water from the public supply network were included. The JBI Critical Appraisal Tools for Systematic Reviews was used to assess the risk of bias of the studies. A proportion meta-analyses using random-effect models were performed. The heterogeneity between studies was determined by I2 statistic. Meta-regressions were conducted to identify relevant moderators to be used in stratified meta-analyses. Publication bias was investigated by Egger’s tests. Results The search provided 2038 results, from which 14 met the eligibility criteria and were included in the data extraction of the review. Overall, the water samples were collected from 449 different sources in three Brazilian regions. Thirteen studies presented a low risk of bias. The mean concentration of fluoride ranged from 0.17 to 0.89 ppmF. The meta-analyis demonstrated that more than half of the water samples analyzed had fluoride concentration levels outside the acceptable range (56.6%; 95% CI 45.5; 67.3), with high heterogeneity. Conclusion More than half of the public water supply analyzed in the studies selected had fluoride concentration levels outside the acceptable range, which may affect the risk of developing oral diseases in the Brazilian population, having an important impact on public health.

Objective: To evaluate the association of dental pain with time living on the street in a sample of homeless people in the city of Porto Alegre, Brazil. Methods: A cross-sectional study was carried out with homeless people who accessed social services in 2017. A questionnaire was administered covering socioeconomic variables and including questions about general health, use of tobacco/alcohol/drugs, use of dental services and history of dental pain. The decayed, missing, and filled teeth (DMFT) index was calculated in an oral examination. The association between socioeconomic characteristics, health status, time of homelessness and dental pain was evaluated using chi-square, t-, and Mann-Whitney tests. Results: A total sample of 214 homeless people was surveyed. Most were male (76.2%), had a low level of education (67.6%) and experienced many episodes of dental pain during life (91.0%). The last episode of pain was moderate or intense (79.7%) and do-it-yourself measures for pain relief were preferred (62.3%). Individuals who were homeless for longer than 1 year had more dental pain in the past (P < 0.001), more frequency of a recent episode of dental pain (P = 0.03), and sought a dentist or healthcare service to relieve pain less frequently (P = 0.03). Conclusions: Dental pain is frequent in the context of homelessness and does not necessarily result in seeking dental services, even where there is universal oral health care.

Abstract This study aims to assess the magnitude and trend of mortality rates due to oral (OC) and oropharyngeal cancer (OPC) in the 133 Intermediate Geographic Regions (IGR) of Brazil between 1996 and 2018 and to analyze its association with sociodemographic variables and provision of health services. It also aims to compare the trend of mortality from neoplasms that have been reported as associated with HPV (OPC) with the trend of neoplasms that have been reported as not associated with HPV (OC). We obtained mortality data from the Mortality Information System in Brazil and analyzed the trends using the Prais-Winsten method. Then, we assessed the relationship between mortality trends and socioeconomic, health spending, and health services provision variables. The median of the annual percent change of the country’s mortality rates was 0.63% for OC and 0.83% for OPC. Trends in mortality in the IGRs correlated significantly with the Human Development Index and government expenditure on ambulatory health care and hospitalizations. Mortality from both types of cancer decreased in those IGR in which the government spent more on health and in the more socioeconomically developed ones. This study found no epidemiological indication that HPV plays the leading etiological factor in OPC in Brazil.

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 analyze the prevalence of dental visits due to toothache and tooth extraction in Brazil and its association with individual and contextual variables. This two-step cross-sectional study included persons aged 18 years and older in the 2019 National Health Survey who had visited a dentist in the 12 months prior to the interview (n = 40,369). The individual-level outcome was having a dental visit due to toothache or tooth extraction. The ecological-level outcome was the proportion of dental visits for these reasons relative to all dental visits by Brazilian state. Associations with individual – sociodemographic characteristics, number of teeth, and type of health service used – and ecological variables – HDI and dental service coverage – were assessed using Poisson regressions. The prevalence of dental visits due to toothache or extraction was higher among individuals with no formal education, household income < 25% of the minimum wage, of black and brown skin color, living in rural areas, who consulted in the public health system, with 10–19 and 1–9 teeth, and men. The proportion of dental visits due to toothache/extraction in Brazilian states was negatively associated with the HDI and the rate of dental emergency team/100,000 inhabitants and positively associated with primary dental care coverage. The prevalence of dental visits due to toothache/extraction was associated with individual and ecological characteristics, indicating inequities in reasons for dental visits in Brazil. The potential of a well-structured oral health care network to overcome these inequities is suggested and needs to be better explored.

Objective: To analyze the association between Early Childhood Caries (ECC) and mother´s knowledge, attitudes, and practices (KAP). Material and Methods: This cross-sectional study included a random sample of 163 preschool children aged 3-4 old in southern Brazil. The severity of dental caries and ECC was assessed by ICDAS criteria, while mothers completed the semi-structured questionnaire (KAP-ECC). Maternal behavior characteristics and answered questions about socioeconomic and demographic variables. Logistic regression was performed to evaluate the association of exploratory variables with ECC. For this approach, we calculated the odds ratio (OR) and 95% confidence intervals (95% IC). Results: Dental examinations revealed that 91.4% of children presented ECC (ICDAS = 3, 4, 5 or 6). Among those children, 31.9% presented cavities (ICDAS ≥ 3). Family income was significantly associated with the presence of ECC (OR 2.17; 95% CI: 1.41-3.36). Regarding KAP-ECC, mothers have knowledge related to ECC etiology, reported dental hygiene attitudes and practices that can prevent ECC but reported less healthy attitudes and practices regarding child’s diet, specifically with respect to bottle and breastfeeding habits (OR 0.52; 95% CI: 0.33-0.81). Conclusion: ECC was more frequent in children from low-income families and whose mothers reported the belief that milk with chocolate does not contribute to caries and that disagreed that it is normal that a 2-year-old baby wakes up during the night to suckle. That is, good knowledge toward health habits may impact on lower occurrence of ECC; however, this condition also depends on the socioeconomic level.

Objective: To evaluate the impact of early childhood caries, maternal behaviors and associated factors on the oral health-related quality of life (OHRQoL) of preschool children. Material and Methods: This cross- sectional study was conducted with 163 preschool children aged 3-4 old from Porto Alegre, Southern Brazil. Mothers completed the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) and answered questions about sociodemographic and maternal behaviors characteristics. The severity of dental caries was assessed by ICDAS criteria for evaluated early childhood caries (ECC). A Poisson regression model was used to investigate the association of ECC and associated factors on OHRQoL. Results: A total of 91.4% of preschooler children was ECC (ICDAS ≥ 1). Mean ECOHIS function domain and parental anxiety domain scores were significantly higher in children with dental caries (p

El programa Brasil Sonriente (BS) fue creado por el gobierno federal de Brasil, como parte de su Sistema Único de Salud, en el año 2004. Dicho programa provee decenas de miles de equipos de salud bucal en la atención primaria básica, establece atenciones de mediana complejidad y fomenta las políticas municipales de fluorización del suministro de agua y rehabilitación bucal protésica, por medio de los laboratorios regionales de prótesis dental, entre otras acciones. La Política Nacional de Salud Bucal (PNSB) y su programa BS son reconocidos como responsables del aumento en el acceso a los servicios de salud pública. Aproximadamente 15 años después de la implementación de la PNSB, pueden ser observados avances importantes: aumento exponencial en la cobertura de los equipos de salud bucal en la atención básica y un enfoque del cuidado integral de la salud. Sin embargo, los puntos positivos no pueden ocultar los obstáculos que aún existen. La municipalización del sistema de salud se llevó a cabo bajo el amparo de la redemocratización y la premisa del empoderamiento de los actores locales en la discusión de un modelo de salud más conveniente para ofrecer servicios a los usuarios. Sin embargo, la forma en que el Estado brasilero se organiza y financia distorsionó la estructura de las redes integrales de atención en salud.

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.

Abstract INTRODUCTION: Cancers are the second main cause of morbidity worldwide, but robust information on lip, oral cavity, and pharynx cancers in Brazil is lacking. This study aimed to analyze the trends of incidence and mortality caused by lip, oral cavity, and pharynx cancers and age-period-cohort effects in the Brazilian population of 30 years of age and over, in the period of 1990 to 2019. METHODS: A time series study of the incidence and mortality rates for oral cavity and pharynx cancer (“Lip and oral cavity cancer”, “Nasopharynx cancer”, and “Other pharynx cancer”) was conducted, with corrected data from the Global Burden of Disease Study (GBD) 2019. Age-standardized rates per 100,000 inhabitants, for the global population, were gathered according to the individuals’ sex. The annual average percentage change (AAPC) was estimated, as was the age-period-cohort effects. RESULTS: The incidence and mortality rates were higher for men in the studied anatomical regions. The cancers tended to decrease for men, except for nasopharynx cancer, which increased in individuals of both sexes. Mortality tended to present a decline in most of the groups studied. For men and women, the age-period-cohort model presented a better adjustment for both incidence and mortality. CONCLUSIONS: Incidence and mortality caused by the main head and neck cancers showed a tendency to decline over the past 30 years in Brazil, except for nasopharynx cancer, which showed an increase in incidence and mortality in some segments of the population. Higher rates were found for lip and oral cavity cancers in men.

Abstract: We aimed to verify the association between different socioeconomic indicators and self-rated health in a nationally representative sample of older adults. This cross-sectional study analyzed the baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a population-based cohort study of persons aged 50 years or older. Data was collected using a household and an individual questionnaire at participants’ households. Self-rated health was assessed by a global self-rating item. Three socioeconomic indicators were assessed: individual income, per capita household income, and wealth index. Poisson regression models were performed to estimate the prevalence ratio (PR) and 95% confidence intervals (95%CI) of self-rated health and each socioeconomic indicator, adjusting for covariates. In total, 9,390 older adults answered the outcome question. Whilst for the individual income indicator only the richest quintile showed a statistically significant association with the outcome (PR: 0.90; 95%CI: 0.87; 0.93), for the per capita household income, the fourth (PR: 0.95; 95%CI: 0.91; 0.98) and the fifth quintiles (PR: 0.90; 95%CI: 0.86; 0.94) remained associated with the outcome. Regarding the wealth index, only the second quintile was not associated with the outcome, with lower prevalence of poor self-rated health as richer was the quintile, showing a social gradient. The wealth index seems to be a more adequate indicator, as it reflects resources accumulated over the life course.

ABSTRACT OBJECTIVE Analyze the performance of the oriented oral health care network from its implementation, in 2004 to 2020, according to publications on the subject. METHODS This is a research with a methodological description of metasynthesis. RESULTS The searches resulted in 600 complete publications (586 in the first search and another 14 in the second search), according to the established criteria. 539 articles were excluded: 151 after duplication analysis, 236 after reading the title, 45 by type of publication and 107 after reading the abstract, as they did not fit the research theme. Thus, 61 original publications and another 29 publications in snowball sampling were selected and analyzed, totaling 90 publications. From this selection, we chose to use the model proposed by the Projeto de Avaliações de Desempenho de Sistemas de Saúde (PROADESS — Health Systems Performance Assessment Project). The study will use its guiding principles on the dimension “Health Services Performance”. CONCLUSION The analyzed set allowed us to identify that the way the Brazilian State organizes and finances oral health care made it possible to expand access and the number of procedures performed, but not the creation of an effective comprehensive care network, after more than a decade of implementation of Brasil Sorridente (Smiling Brazil).

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.

The aim of this study was to present a concise summary of the oral health policies and oral healthcare schemes for older adult populations in a number of selected countries around the world. In this paper, the current and planned national/regional oral health policies and oral healthcare schemes of nine countries (Australia, Brazil, China including Hong Kong, India, Japan, Switzerland, Thailand, the United Kingdom, and the United States) are reported. Barriers and challenges in oral health promotion in terms of devising oral health policies, implementing oral health schemes, and educating the future dental workforce are discussed. In response to the aging of population, individual countries have initiated or reformed their healthcare systems and developed innovative approaches to deliver oral health services for older adults. There is a global shortage of dentists trained in geriatric dentistry. In many countries, geriatric dentistry is not formally recognized as a specialty. Education and training in geriatric dentistry is needed to produce responsive and competent dental professionals to serve the increasing number of older adults. It is expected that oral health policies and oral healthcare services will be changing and reforming in the coming decades to tackle the enduring oral health challenges of aging societies worldwide.

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: Objectives: This study investigated the impact of the COVID-19 pandemic on the provision of dental care procedures performed by the Brazilian Unified Health System (SUS) nationally and by regions. Considering that the most underprivileged population disproportionately suffers with the reduction in dental care provision, the study hypothesis suggests the presence of a syndemic nature. Methodology: The SUS Outpatient Information System (SIA-SUS) was assessed to gather data on dental care activities and procedures performed between April and July 2018, 2019, and 2020 by dentists registered in the SUS. The 30 most frequent activities and procedures performed by dentists were selected and classified into three categories (urgent dental care, nonemergency dental care, and case-dependent urgency procedures), based on the guidance for dental care during the pandemic published by the American Dental Association. Results: Results demonstrated a reduction in the provision of dental care of all categories during the pandemic. Urgency dental consultations and procedures in primary and specialized dental care services decreased by 42.5 and 44.1%, respectively, between 2020 and 2019. Non-urgent procedures decreased by 92.3%. Although decreases in dental care activities and procedures were reported in all Brazilian regions, the largest relative decreases in urgent procedures – that should have been maintained during the pandemic – occurred in the North and Northeast regions, which are the poorest regions of the country. Conclusions: These results suggest that the COVID-19 pandemic has a syndemic behavior. Further investigation into the pandemic-syndemic impacts on oral disease burden is necessary.

ABSTRACT Purpose: to evaluate the lingual frenulum and breastfeeding in infants from a maternal-perinatal referral center, as well as to monitor infants with ankyloglossia up to six months of age. Methods: a cohort study conducted at the Instituto Nacional Materno Perinatal - Maternidad de Lima in Lima, Peru. The consecutive intentional sample consisted of 304 newborns and their respective mothers, evaluated during December 2017 and January 2018, which were the baseline of the study. A clinical evaluation of the lingual frenulum adapted and the Clinical Evaluation of Breastfeeding Efficacy (CEBE) scale, was performed. Results: of the 304 newborns, 15 (4.9%) were considered with altered frenulum, and only 4 (26.7%) presented a low score in CEBE. The mean of the CEBE score was 9.3. (DP=1.35, Min=3, Max=10). Of the follow-up infants, only 2 (13.3%) persisted with breastfeeding difficulties for which frenotomy was indicated. Conclusion: This study demonstrates the low prevalence of ankyloglossia in infants, as it does not indicate a trend of difficulty or negative interference in breastfeeding.

Resumo Objetivo: Avaliar a prevalência e os fatores associados à realização de acolhimento pelas equipes da Atenção Básica à Saúde no Brasil. Métodos: Estudo transversal, realizado com equipes que aderiram ao PMAQ-AB 2012 (Ciclo I). O desfecho utilizado foi o ‘acolhimento pela equipe de saúde’; as variáveis independentes foram macrorregião, perfil municipal, índice de Gini e cobertura populacional da Estratégia Saúde da Família, reunião de equipe, estudo da demanda espontânea, consideração da opinião do usuário e existência de educação permanente. Realizou-se análise multinível, por regressão de Poisson. Resultados: A amostra foi composta por 13.751 equipes. A prevalência de acolhimento foi de 78,3% (IC95% 77,6;79,1). Na análise hierárquica, a maior prevalência de acolhimento foi entre as equipes pertencentes à região Sul (RP=1,37 – IC95% 1,27;1,48), tendo por referência a região Nordeste. Conclusão: Há uma distribuição desigual de equipes da Atenção Básica que realizam o acolhimento no país, possivelmente associada às iniquidades regionais.

ABSTRACT: Objective: To test the factorial validity and reliability of the Primary Care Assessment Tool adapted to Oral Health, adult patient version, an instrument used to verify the presence and extent of attributes in Primary Health Care services. Methods: Population-based cross-sectional study using conglomerate random sample carried out in Primary Health Care Dental services in Porto Alegre between 2011 and 2013. We interviewed 407 adult patients who used Primary Health Care Dental services. Construct validity was tested through factorial validity and reliability of the Primary Care Assessment Tool, that comprises 81 items distributed throughout Primary Health Care attributes. Equamax orthogonal rotation method was used in the factorial analysis; and, in order to assess reliability of each component, we used the item-total correlation and the ratio of success of the scale. Results: In the factorial analysis, 10 factors were retained, explaining 53.3% of the total variation. This result demonstrates the multidimensional structure of the instrument. The reliability assessment showed Cronbach’s alpha values ranging from 0.39 to 0.89. For the success of the scale most of the results (eight of nine attributes) were greater than 85%. Conclusions: The instrument is valid for the assessment of oral health services in Primary Health Care from the perspective of adult patients, as well as for monitoring and evaluation of oral health services in Primary Health Care attributes and comparative studies.

RESUMO: Objetivo: Barreiras à comunicação são principais dificultadores do acesso de pessoas com deficiência sensorial (visual e auditiva) aos serviços de saúde. Os objetivos do estudo foram analisar a prevalência e os fatores associados à presença de facilitadores à comunicação nas unidades básicas de saúde no Brasil. Métodos: Estudo transversal multinível sobre dados de 38.811 unidades de saúde de 5.543 municípios, entre 2012 e 2013, coletados no Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Desfecho criado agrupando facilitadores à comunicação (material em relevo/braille; recurso auditivo; comunicação visual; listagem acessível de ações do serviço; profissional para acolhimento de usuário com deficiência sensorial). As variáveis de exposição do nível I (contextuais) foram: macrorregião, porte populacional e produto interno bruto (PIB) per capita. No nível II, (serviço) foram: equipe ampliada; modelo de atenção; turnos de atendimento; sala de acolhimento; divulgação do horário de atendimento; presença de facilitadores ao acesso físico. Utilizou-se regressão de Poisson multinível com modelagem hierárquica em dois estágios. Resultados: A presença dos facilitadores à comunicação é pequena nas unidades de saúde (32,1%), sendo mais frequentes nas unidades localizadas nos municípios com maior PIB (razão de prevalência - RP = 1,02, intervalo de confiança de 95% - IC95% 0,92 - 1,12) e porte populacional (RP = 1,25, IC95% 1,02 - 1,52). Conclusão: Ter profissional para acolhimento é o principal facilitador ao acesso e deve ser foco de ações para melhorar a atenção à saúde das pessoas com deficiência. Faz-se necessário promover acesso universal, com adequação de serviços, remoção de barreiras à comunicação e estímulo ao acolhimento do usuário.

Abstract The aim of this study was to verify the association between sociodemographic, general health, and oral health data with self-rated general health (SRGH) and self-rated oral health (SROH) in independent-living older Brazilians. This cross-sectional study was part of a larger study with older individuals living independently in the city of Campinas, Brazil – the “Rede FIBRA” Study (the Frailty in Brazilian Elderly Study). A random sample of 688 older individuals responded the SRGH and 673, the SROH. SRHG and SROH were both assessed using a single item. The questionnaire included sociodemographic, general, and oral health data. The mean age was 72.28 ± 5.4 years. The adjusted analysis revealed that the probability of rating general health as bad was higher for illiterate participants (PR: 1.77, 95%CI: 1.13–2.77) or with low educational level (PR: 1.76, 95%CI: 1.17–2.65), those with depressive symptoms (PR: 1.45, 95%CI:1.21–1.74), participants that self-reported food limitation due to problems with denture or lack of it (PR: 1.29, 95%CI: 1.05–1.56), and those with xerostomia (PR 1.40, 95%CI: 1.17–1.67). The probability of rating general health as bad was lower for participants that presented 0-2 chronic diseases (PR: 0.64, 95%CI: 0.53–0.78) and were pre-frail (PR: 0.76, 95%CI: 0.61-0.96). With regard to SROH, the probability of rating oral health as bad was higher for participants with natural teeth (PR:1.61, 95%CI: 1.24–2.08), that reported xerostomia (PR: 1.44, 95%CI: 1.13–1.84), and food limitation due to problems with denture or lack of it (PR: 1.43, 95%CI: 1.07–1,91), and lower for participants that reported having enough money to cover daily expenses (PR: 0.78, 95%CI: 0.61–0.99). Oral health data and income seem to be related to self-perceptions of general and oral health.

Part of the oral health care in the care network encompasses users in emergency cases. This study proposed mapping the determinants of the use of dental care services within the health care network to address dental emergencies within the Brazilian Unified Health System (UHS) and to verify the main gaps in the research in this area. This is a scoping review that took place in 2018 using Andersen's behavioral model as a reference. A total of 16 studies, out of 3786 original articles identified, were included and reviewed. Two reviewers independently conducted the selection process and the decision was consensually made. The mapping of the determinants revealed a greater number of enabling factors and a larger gap in the results. Greater use of the emergency service was registered by people in pain, women, adults, those from an urban area, people with a lower income, and those with less education. In future studies, primary surveys are recommended, which include all ages, and analyze different groups of needs and users that take into account the country's northern region and the different subjects pointed out by this review.

Resumo: Objetivou-se avaliar a associação entre presença de Centros de Especialidades Odontológicas (CEO) e a proporção de exodontias em relação ao total de procedimentos odontológicos em serviços públicos do Brasil. Trata-se de um estudo ecológico, em que foram avaliados dados sociodemográficos, dos serviços de saúde bucal e produção ambulatorial de 5.333 municípios nos biênios de 2000/2001 e 2015/2016. A principal variável de exposição foi a presença de CEO, e o desfecho a média nacional da proporção de exodontias em relação ao número de procedimentos odontológicos preventivos e curativos. Foram realizadas análises de interação e regressão múltipla usando modelo binomial com função de ligação logito. A média nacional da proporção de exodontias em relação aos procedimentos odontológicos preventivos e curativos foi 27,07% e 15,11% em 2000/2001 e 2015/2016, respectivamente. Na análise de interação entre a presença de CEO e a cobertura superior a 80% de equipes de saúde bucal (ESB), houve menores proporções de exodontias em relação aos procedimentos odontológicos preventivos e curativos (OR = 0,71; IC95%: 0,71-0,72). Na análise de regressão múltipla, municípios com Índice de Desenvolvimento Humano entre 0,6-0,7 (OR = 0,77; IC95%: 0,77-0,77), Produto Interno Bruto per capita maior que 20 mil Reais (OR = 0,45; IC95%: 0,45-045) e maior população residente em zona urbana (OR = 0,72; IC95%: 0,72-0,72) apresentaram menor proporção de exodontias em relação aos procedimentos odontológicos preventivos e curativos em 2015/2016. Conclui-se que ocorreram menores proporções de exodontias em relação aos procedimentos odontológicos preventivos e curativos em municípios com ao menos um CEO e com mais de 80% de cobertura de ESB, o que aponta que municípios com Rede de Atenção à Saúde Bucal consolidada têm melhor desempenho na oferta de cuidados odontológicos.

O acesso aos serviços básicos de saúde ainda mostra-se como um processo em construção e que necessita de esforços conjuntos do poder público, dos profissionais e de pesquisadores da saúde coletiva para descrever, traçar planos para o enfrentamento dos problemas e construir acesso universal ao que se considera, dentro das políticas públicas, como essencial a saúde do cidadão brasileiro nos grandes centros urbanos. Nestes pressupostos, o objetivo deste estudo foi analisar o acesso aos serviços de Atenção Primária à Saúde (APS) por meio da percepção do usuário adulto em três Gerências Distritais de Porto Alegre/RS. Estudo de base populacional realizado com 214 usuários. Utilizou-se questionário construído especificamente para a pesquisa contendo o atributo Acesso de Primeiro Contato do Primary Care Assessment Tool/PCATool, versão adulta, que foi aplicado através de um aplicativo para tablets. Como resultado 65,0% dos participantes eram usuários dos serviços básicos de saúde ofertado no Sistema Único de Saúde. No geral, o acesso foi insatisfatório. Em contraste, Acesso de Primeiro-Contato/Utilização foi percebido como satisfatório. Além disso, Acesso de Primeiro-Contato/Acessibilidade e o Escore Acesso apresentaram um desempenho insatisfatório. Destaca-se a importância de analisar dados sociodemográficos para o funcionamento da APS. Enfatiza-se a necessidade do município em direcionar esforços para a parte da população que percebeu o acesso como um atributo insatisfatório.

Aim: To verify if self-report is a valid instrument to study the clinical oral condition in older people without cognitive deficit. Methods: A Cross-sectional study was conducted with 647 older people from the community, without cognitive deficit, living in Campinas, Brazil. A self-report questionnaire assessing the presence or absence of teeth (edentulism) and use of complete denture was applied, identifying the location of the denture, whether in the upper and/or lower arch. In the same session oral clinical exams were performed, considered the gold standard. The self-report validation was performed by calculating sensitivity, specificity, predictive values, odds ratios and Kappa agreement. Results: There were high percentages of sensitivity (95–99%), specificity (84–97%), positive (81–97%) and negative (95–98%) predictive values, obtaining an elevated level of confidence and quality intrinsic value of self-report. Agreement with the clinical examination was excellent for all variables (greater than 0.80). The likelihood ratios showed compelling evidence that with self-report an edentulous individual (+LR 32), non-edentulous (-LR 0.06) and absence of complete denture (-LR 0.01) could be correctly identified, with moderate evidence to identify the presence and location of complete denture use (+LR 6.5 to 6.9). Conclusion: Self-report is a valid instrument to study the clinical oral condition in the older people of the community.

Abstract: The objective was to investigate if there is an association between the mortality rates due to oral and oropharyngeal cancer in Brazil and the expansion of access to public primary and specialized dental care services that resulted from the implementation of the National Oral Health Policy, between 2000 and 2013. The mortality data were obtained from the records of the Mortality Information System and the exposure variables were obtained from databases of the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics. The main exposures investigated were “coverage of primary dental care” and “number of specialized dental care centers”. Additional covariates included “Gini index of household income”, “average number of years of study”, “proportion of unemployed people” and “proportion of smokers”. For the statistical analysis, a random coefficient model was used. There was a statistically significant association between the mortality rates by oral and oropharyngeal cancer with coverage by primary dental care and the number of specialized dental care centers with males. This study found that the expansion of the coverage of primary dental care and the number of specialized dental care centers are associated with the reduction of mortality rates due to oral and oropharyngeal cancer in Brazil. There is plausibility for the association found, which needs to be confirmed by implementation studies.

Abstract Oral and oropharyngeal cancer is considered a public health problem in several countries due to its high incidence and mortality rate. Objective: This study aimed to analyze oral and oropharyngeal cancer mortality in Uruguay from 1997 to 2014 by age, sex and country region. Methodology: A time series ecological study using secondary data was performed. Data on mortality due to oral and oropharyngeal cancers were obtained from the Vital Statistics Department of Uruguay's Ministry of Public Health. Results: The cumulative mortality rate due to oral and oropharyngeal cancer over the study period was of 19.26/100,000 persons in women and 83.61/100.000 in men, with a mean annual rate of 1.75/100,000 in women and 7.60/100,000 in men. Mortality rate from both sites during the study period was 4.34 times higher in men than in women. Malignant neoplasms of other parts of the tongue and base of tongue showed the highest mortality rate. The means of the annual coefficients of deaths were higher for the age groups between 50 and 69 years. Higher mortality rates of oral and oropharyngeal cancer were observed in Artigas (4.63) and Cerro Largo (3.75). Conclusions: Our study described a high mortality rate for oral and oropharyngeal cancer in Uruguay from 1997 to 2014. According to the country's health department, men, tongue cancer, and oral cavity had higher mortality rates, with some variation. Prevention strategies with control of risk factors and early diagnosis are necessary to improve survival in the Uruguayan population.

ABSTRACT Purpose To describe the presence of speech-language therapists (SLT) in the primary health care (PHC) in Brazil and its association with socioeconomic inequalities. Methods Cross-sectional study with 17,157 PHC services in all Brazilian states. Based on the NASF External Assessment Questionnaire sub-item “speech-language therapist”, which was used to answer the question “What NASF professionals support your PHC service?”, in addition to contextual data (regional population, number of registered SLP, speech therapy college courses, city HDI and Gini Index). Results From all the PHC services supported by NASF, 50.8% (8713/17,157) has SLPs as part of the team. Brazil’s Southeast region has the higher prevalence of SLP at the team (57.4%; 5,575). South Region has the lower prevalence (28.9%; 625). The presence of SLP support is directly proportional to HDI stratum and Gini Index (average and high). Conclusion There is an important limitation of public care to treat communication and swallowing disorders in Brazil.

Aim: To investigate tooth loss and its determinants in adolescents, considering the effect of extractions due to orthodontics reasons. Methods: This cross-sectional study was performed in students from public and private schools aged 15-19 years old from Passo Fundo, Brazil. The proportional randomly chosen sample included 736 adolescents. Clinical examinations and interviews were performed. Associations between prevalence of tooth loss and exposure variables studied were analysed by Poisson Regression with uni- and multivariate robust variance in two models. One model comprised students who had experienced tooth loss without orthodontic reasons and the other with all of the subjects presenting tooth loss. Results: Prevalence of tooth loss was 21.1% (mean of 0.42). Higher chances for tooth loss were found in the following features: non-whites (PR=1.72; CI95%:1.15-2.60), poorly schooling mothers (PR=2.2; CI95%:0.96-5.02), from public schools (PR=4.16; CI95%:0.98-17.59), smokers (PR=1.91; CI95%:1.15-3.17). Conclusion: Demographic, socioeconomic and behavioural conditions were strongly associated with tooth loss. These associations were more evident when extractions for orthodontic reasons were not included in the analytical models.

ABSTRACT OBJECTIVE To evaluate if the provision of clinical dental care, by means of the main curative procedures recommended in Primary Health Care, is associated with team structural characteristics, considering the presence of a minimum set of equipment, instrument, and supplies in Brazil’s primary health care services. METHODS A cross-sectional exploratory study based on data collected from 18,114 primary healthcare services with dental health teams in Brazil, in 2014. The outcome was created from the confirmation of five clinical procedures performed by the dentist, accounting for the presence of minimum equipment, instrument, and supplies to carry them out. Covariables were related to structural characteristics. Poisson regression with robust variance was used to obtain crude and adjusted prevalence ratios, with 95% confidence intervals. RESULTS A total of 1,190 (6.5%) dental health teams did not present the minimum equipment to provide clinical dental care and only 2,498 (14.8%) had all the instrument and supplies needed and provided the five curative procedures assessed. There was a positive association between the outcome and the composition of dental health teams, higher workload, performing analysis of health condition, and monitoring of oral health indicators. Additionally, the dental health teams that planned and programmed oral health actions with the primary care team monthly provided the procedures more frequently. Dentists with better employment status, career plans, graduation in public health or those who underwent permanent education activities provided the procedures more frequently. CONCLUSIONS A relevant number of Primary Health Care services did not have the infrastructure to provide clinical dental care. However, better results were found in dental health teams with oral health technicians, with higher workload and that plan their activities, as well as in those that employed dentists with better working relationships, who had dentists with degrees in public health and who underwent permanent education activities.

The Brazilian network of emergency care, in recent years, has shown significant progress. The objective was to evaluate contextual and individual factors associated with the satisfaction with public emergency health services. This was a cross-sectional multilevel study carried out between June 2011 and January 2012. Data were collected via telephone at the ombudsman’s office of the Brazilian Unified National Health System (SUS). Telephone numbers were randomly selected from a telephone company database. Health services, socioeconomic, and individual demographic variables were evaluated, in addition to information about the municipalities. The outcome variable was dissatisfaction with public emergency health services in Brazil. Multilevel logistic regression was performed and 7,027 individuals from 61 municipalities answered the survey. The prevalence of perceived dissatisfaction was 48.1% (95%CI: 46.9-49.3). Variables that remained significantly associated with the outcome are: age up to 20 years, 16 or more years of education, lives in the Central region, non-resolved demands, longer waiting times, and accessing emergency in a primary care service. Prevalence of a perceived dissatisfaction is predominantly associated with care’s waiting time and the length needed to resolve the demand.

The aim of this study was to test Wilson & Cleary’s conceptual model of the direct and mediated pathways between clinical and non-clinical variables in relation to oral health-related quality of life. A random sample of 578 older people was evaluated. Wilson & Cleary’s conceptual model was tested using structural equations modeling including: biological variables, symptom status, functional health, oral health perceptions, oral health-related quality of life. Oral health-related quality of life was assessed with the Oral Health Impact Profile-14 (OHIP-14). In the final model, edentulism was negatively correlated to dissatisfaction of appearance of their dental prostheses (r = -0.25). Worse functional status was correlated with poor oral health perception (r = 0.24). Being aged over 68 (r = 0.25), being a female (r = 0.39) and living in rural areas (r = 0.15) had a direct effect on the edentulism. Age had a direct effect on OHIP-14 (r = -0.15). There was an indirect effect of sex on OHIP-14 via functional status (r = 0.12). The present findings partially support Wilson & Cleary’s model framework.

OBJETIVO: Avaliar a associação entre resiliência e qualidade de vida relacionada à saúde bucal, por meio de uma abordagem hierárquica baseada em um modelo teórico conceitual em uma coorte de idosos do Rio Grande do Sul. MÉTODOS: Foi conduzido um estudo transversal aninhado a um estudo de coorte, em 2008. Foram avaliados 498 idosos de Carlos Barbosa, Rio Grande do Sul. As medidas avaliadas foram sociodemográficas, comportamentos de saúde, qualidade de vida relacionada à saúde bucal, medida pelo Oral Health Impact Profile (OHIP-14), Escala de Resiliência e CPOD. A associação entre o potencial de resiliência e os impactos na percepção de saúde bucal relacionados à qualidade de vida foi verificada por meio de regressão binomial negativa. Razões das médias (RM) são apresentadas com seus intervalos de confiança de 95% (IC95%). RESULTADOS: Maiores médias do OHIP foram encontradas entre mulheres (6,7 ± 6,3; p = 0,011), moradores da zona rural (7,3 ± 6,7; p = 0,004) e solteiros (8,0 ± 6,3; p = 0,032). O modelo final da análise multivariada mostrou que ser morador da zona rural (RM = 1,32; IC95% 1,06 - 1,65) e casado (RM = 1,36; IC95% 1,07 - 1,72) foram variáveis independentemente associadas à qualidade de vida relacionada à saúde bucal. Não houve associação entre resiliência e qualidade de vida relacionada à saúde bucal. CONCLUSÃO: Os resultados sugerem que variáveis sociodemográficas estão associados à qualidade de vida relacionada à saúde bucal. A hipótese de que a resiliência pudesse exercer um papel importante no desfecho não foi confirmada.

The aim of this study was to evaluate the demographic, clinical, and therapeutic characteristics and predictive factors of poor prognosis in patients with primary oral squamous cell carcinoma (OSCC) in Uruguay. Medical records of patients with the diagnosis of primary OSCC treated between 2000 and 2010 in Uruguayan public hospitals were selected. Data on demographic characteristics, risk factors, clinical features, treatment, and outcome were collected. Associations of independent variables with outcomes were assessed using Pearson chi-squared and Fisher's tests. Of 200 patients with OSCC, 79.4% were men (3.8:1 male:female ratio), with a mean age of 60.75 ± 11.26 years. Tobacco and alcohol consumption were reported by 85.3% and 63.5% of patients, respectively. The most commonly affected location was the tongue (42.5%), with lesions exhibiting ulcerous aspects in 87.9% of cases and pain at the time of diagnosis in 70.4% of cases. One hundred sixty-one (82.1%) patients had advanced-stage (III/IV) OSCC. Surgery was the most common treatment option, and the overall 5-year survival rate was 58.5%. Univariate analysis showed that the predictors of poor prognosis were clinical aspect, size, regional metastasis, clinical stage, and treatment. In Uruguay, OSCC is diagnosed late, which is associated with a low survival rate. Educational and preventive measures and investment to improve early diagnosis should be undertaken.

This study investigated the impacts of oral health-related quality of life (OHRQoL) on daily activities and work productivity in adults. A cross-sectional study was conducted in a supermarket chain in the state of São Paulo, which included 386 workers, age-range 20 – 64 years. Participants were examined for oral disease following WHO recommendations, and the oral health impact profile (OHIP) assessment was used to determine OHRQoL. Demographic, socio-economic, use of dental services, and OHRQoL data were obtained. Answers to the OHIP were dichotomized into no impact and some impact, and the relationship to OHRQoL was determined. Poisson regression with robust variance was performed using SPSS version 17.0. Dimensions with highest OHIP scores were physical pain and psychological discomfort. Sex (male: PR = 0.55, 95% CI 0.38 – 0.80), lower family income (PR = 1.49, 95% CI 1.04 – 2.12), visiting a dentist due to pain (PR = 2.14, 95% CI 1.57 – 3.43), tooth loss (PR = 1.59, 95% CI 1.09 – 2.32), and needing treatment for caries (PR = 1.59, 95% CI 1.09 – 2.32) were most likely to impact OHRQoL. Therefore, socioeconomic and demographic status and use of dental services impacted OHRQoL. These results indicate that oral health promotion strategies should be included in work environments.

Objective: To investigate if there is convergent validity between the dimensions of the World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-Bref) and the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Methods: In this cross-sectional study, a random sample of 872 elderly Southern-Brazilians was evaluated. Questionnaires assessing socio-demographic data and quality of life in general (WHOQOL-Bref) and oral health-related quality of life (OHIP-14) were used. Analysis of the WHOQOL-Bref and OHIP-14 questionnaires used descriptive statistics. The dimensions of the WHOQOL-Bref and OHIP-14 questionnaires were correlated by affinity. The convergence between WHOQOL-Bref and OHIP-14 dimensions was analyzed by Spearman’s correlation coefficients. Results: The social relations dimension of the WHOQOL-Bref presented the greatest mean (18.24 ± 2.30). The physical pain dimension of the OHIP-14 presented a median of 1.0 (0.0 – 3.0). All correlations between the WHOQOL-Bref and OHIP-14 dimensions were significant, negative and associated with a low magnitude. The correlation between WHOQOL-physical and OHIP-functional limitation, OHIP-physical pain, OHIP-physical disability and OHIP-handicap were – 0.164, – 0.262, – 0.196 and – 0.125 respectively. WHOQOL-psychological was associated with OHIP-psychological discomfort and OHIP-psychological disability, and WHOQOL-social showed an association with OHIP-social disability. Conclusions: All correlations analyzed had a positive association of low magnitude. Despite the fact that the WHOQOL-Bref and OHIP-14 instruments have related dimensions, they measure physical, psychological and social relations differently.

Abuse of the elderly is a form of violence to come to the public's attention. Dental professionals are in an ideal position to identify physical abuse. The aim of this study was to assess the prevalence of elderly abuse and analyze the database of injury reports that can be identified by dental teams. A documentary analysis study developed by the Elderly Protection Police Station of Porto Alegre, Rio Grande do Sul, was carried out. The information used came from 2,304 complaints filed at the aforementioned institution between the years of 2004 and 2006. The records of abuse are categorized as injury, neglect, mistreatment, theft, financial abuse, threat, disturbing the peace, atypical fact, and others. The injuries that could be identified by the dental team were classified according to the injury's location in the area of the head, face, mouth and neck. Descriptive analysis was performed, and chi-square tests were used to evaluate the distributions of the types of elder abuse in relation to sex and age. The most frequent of the different types of abuse was theft, with a prevalence of 17.8%, followed by disturbing the peace at 11.8%. Disturbing the peace, threat, and bodily injury were significantly associated with women. Elder abuse among women and men declines with age. The prevalence of head injury was 25% of the total injuries, most often in females, and in those aged < 70 years. Based on these results, it is necessary that the dental team observe the elderly person's appearance for suspicious physical signs.

The aim of this study was to investigate the dimensional structure of the Oral Health Impact Profile-14: (OHIP-14). Data was obtained from studies carried out in Rio de Janeiro (N = 504) and Carlos Barbosa (N = 872), in the State of Rio Grande do Sul, Brazil. Exploratory factor analysis (EFA) was performed to identify the latent dimensions of the OHIP-14. Confirmatory factor analysis (CFA) was carried out of both samples to compare the one-dimensional structure found by the EFA and the proposed three-dimensional structure. This factorial structure was assessed using goodness-of-fit indices. In the Rio de Janeiro study, the eigenvalue was 9.2 and this one factor explained 65.6% of total variance, while in the Carlos Barbosa study the eigenvalue was 7.9 and this one factor explained 56.6% of variance. CFA indicated an adequate fit of the one-factor model for the Rio de Janeiro study (RMSEA = 0.04; CFI = 0.98; TLI = 0.98) and for the Carlos Barbosa study (RMSEA = 0.05; CFI = 0.97; TLI = 0.97). Our findings suggest that the OHIP-14 measures one single construct.El objetivo fue investigar la estructura dimensional del Oral Health Impact Profile-14: (OHIP-14). Los individuos en las muestras provinieron de dos estudios realizados en Brasil, uno en Río de Janeiro (N = 504) y el otro en Carlos Barbosa, Río Grande do Sul (N = 872). Un análisis factorial confirmatorio (AFC) se llevó a cabo para identificar las dimensiones latentes del OHIP-14 y comparar un modelo de estructura unidimensional con un modelo de tres dimensiones. La estructura dimensional fue evaluada a través de índices de calidad de ajuste. La estructura con un factor presentó, en el estudio de Río de Janeiro, un autovalor de 9,2 y esta estructura explicó un 65,6% de la variancia total, mientras que en el estudio de Carlos Barbosa el autovalor fue de 7,9 y esta estructura unidimensional explicó un 56,6% de la variancia total. El AFC realizado indicó un ajuste adecuado para el modelo de 1 factor en el estudio de Río de Janeiro (RMSEA = 0,04; CFI = 0,98; TLI = 0,98) y en el estudio de Carlos Barbosa (RMSEA = 0,05; CFI = 0,97; TLI = 0,97). El modelo de un factor fue más parsimonioso. Nuestros resultados sugieren que el OHIP-14 sea un instrumento unidimensional.O objetivo foi investigar a estrutura dimensional do Oral Health Impact Profile-14: (OHIP-14). Os indivíduos nas amostras foram provenientes de dois estudos realizados no Brasil, um no Rio de Janeiro, Brasil (N = 504) e o outro em Carlos Barbosa, Rio Grande do Sul, Brasil (N = 872). Análise fatorial confirmatória (AFC) foi conduzida para identificar as dimensões latentes do OHIP-14 e comparar um modelo de estrutura unidimensional com um modelo de três dimensões. A estrutura dimensional foi avaliada através de índices de qualidade de ajuste. A estrutura com um fator apresentou, no estudo do Rio de Janeiro, um autovalor de 9,2 e esta estrutura explicou 65,6% da variância total, enquanto que no estudo de Carlos Barbosa o autovalor foi de 7,9 e esta estrutura unidimensional explicou 56,6% da variância total. AFC realizada indicou um ajuste adequado para o modelo de 1 fator para o estudo do Rio de Janeiro (RMSEA = 0,04; CFI = 0,98; TLI = 0,98) e para o estudo de Carlos Barbosa (RMSEA = 0,05; CFI = 0,97; TLI = 0,97). O modelo de um fator foi mais parcimonioso. Nossos resultados sugerem que o OHIP-14 seja um instrumento unidimensional.

The aim of this study was to investigate the dimensional structure of the Oral Health Impact Profile-14: (OHIP-14). Data was obtained from studies carried out in Rio de Janeiro (N = 504) and Carlos Barbosa (N = 872), in the State of Rio Grande do Sul, Brazil. Exploratory factor analysis (EFA) was performed to identify the latent dimensions of the OHIP-14. Confirmatory factor analysis (CFA) was carried out of both samples to compare the one-dimensional structure found by the EFA and the proposed three-dimensional structure. This factorial structure was assessed using goodness-of-fit indices. In the Rio de Janeiro study, the eigenvalue was 9.2 and this one factor explained 65.6% of total variance, while in the Carlos Barbosa study the eigenvalue was 7.9 and this one factor explained 56.6% of variance. CFA indicated an adequate fit of the one-factor model for the Rio de Janeiro study (RMSEA = 0.04; CFI = 0.98; TLI = 0.98) and for the Carlos Barbosa study (RMSEA = 0.05; CFI = 0.97; TLI = 0.97). Our findings suggest that the OHIP-14 measures one single construct.