Oral Health Teams Research Articles

Training in Family Health and its association with work processes of Primary Care Dentistry Teams

The National Oral Health Policy emphasizes the importance of training in Primary Health Care and adapting the work processes to the new health care model. This study seeks to investigate the association between the training of Dental-Surgeons in Family Health and the work process. It involved a cross-sectional and multicentric study, with 18,114 Oral Health Teams that participated on the National Program to Enhance Access and Quality of Primary Health Care. Data were collected through interviews, using a structured questionnaire. Professionals with post-graduate education in Family Health share their schedule with other Primary Care professionals more frequently (PR: 1.04; CI 95%: 1.03 - 1.06), organize their schedule to offer educational activities in Oral Health more frequently (PR:1.03; CI 95%: 1.02 - 1.04), ensure completion of the treatment of patients more frequently (OR: 1.68; CI 95%: 1.19 - 2.38), conduct more home visits (PR: 1.08; CI 95%: 1.07 - 1.09) and use more protocols for prioritizing actions more frequently (PR: 1.06; CI 95%:1.04 - 1.07). Investment in training in Family Health may be important for better performance in Primary Care Dentistry, thereby leading to changes in the model of Comprehensive Oral Health care.

Contextual and individual determinants of non-utilization of dental services among Brazilian adults.

To examine the association of contextual and individual determinants with non-utilization of dental services among Brazilian adults. Data were from adults aged 35-44 years (N = 7,265) from the 2010 Brazilian Oral Health Survey (SB Brasil Project). Non-utilization of dental services was assessed whether the individual has never had a dental visit over the whole life time. Independent variables were selected according to Andersen's behavioral model. Contextual variables included Human Development Index-longevity (HDI-Longevity) (predisposing demographic), HDI-Education and Gini index (predisposing social), integration of oral health teams into Primary Care (enabling health policy), and HDI-Income (enabling financing). Individual data were age and sex (predisposing demographic), ethnicity and schooling (predisposing social), family monthly income (predisposing enabling), perceived dental treatment (perceived need), and decayed teeth (evaluated need). The relationship of contextual and individual variables with non-utilization of dental services was assessed through multilevel logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (95% CI). The prevalence of non-utilization of dental services was 4.7 percent. Adults living in cities with high HDI-Income were less likely to never have a dental visit. The odds of non-utilization of dental services were lower for adults living in cities with high HDI-Longevity. Sex, skin color, dental treatment needs, poor socioeconomic characteristics, perceived dental treatment needs, and decayed teeth were also associated with non-utilization of dental services. The results suggest that contextual enabling and predisposing factors, individual sociodemographic, and needs-related characteristics influence non-utilization of dental services by Brazilian adults.

The Oral Health Team in the Family Health Strategy: Trajectories and Challenges

Objectives:The objective of this study was to review literature focused on the introduction of Brazilian oral healthcare service models, incorporation of Oral Health Teams (OHTs) within the Family Health Strategy (FHS), changes occurring in the work process of the professionals that make up OHTs, difficulties for successful implementation of this new healthcare model and impacts on indicators of oral health.Methods:A review of the literature was conducted through an electronic consultation of the Pubmed and Virtual Health Library (VHL) databases published between 2001 and 2016, using a combination of descriptors. We selected 44 studies for review.Results:Oral healthcare in Brazil evolved from exclusionary and curative models to those aimed at prevention and promotion of health. The increase in government resources dedicated to oral healthcare in Brazil represented an improvement in access to dental treatment, however, some studies demonstrated that OHTs within the FHS still operate by the traditional curative models.Conclusion:Lack of proper planning for hiring OHTs and precariousness of their work contracts were also reported. The need for better managerial planning for implementation of OHTs within the scope of the FHS was demonstrated.

EQUITY IN SPATIAL DISTRIBUTION OF PRIMARY HEALTH CARE IN THE CITY OF MANAUS, AMAZONAS, BRAZIL

Objective. Evaluate the spatial distribution of health services in primary care according to the characteristics of social vulnerability in the city of Manaus, Amazonas, Brazil.Methods. Selection of the census tracts that compose each human development unit was performed, creating a geographic database. Indicators were selected for each territorial unit and two constructs of social vulnerability were predicted using principal component analysis: one crude and other weighted by the population size. Four maps were created showing quintiles distribution of the constructs, with an overlap of spatial distribution of the coverage area of the family health and oral health teams. The descriptive analyzes of each map were performed.Results. 62.1% of the territories of the existing family health teams and 74.2% of the oral health teams were located in areas of greater social vulnerability, represented by the two worst construct quintiles. However, when considering the resident population, an increase of the teams coverage in areas of lower weighted vulnerability was observed.Conclusion. Despite low coverage the health teams were concentrated on areas of greater social vulnerability. Considering the population distribution of the municipality would allow an even more equitable distribution of health teams regarding organizational accessibility once it is expected that an equitable geographical distribution minimize barriers to access and improve the health conditions and quality of life of the population. The differences in levels of social vulnerability must be considered when making health policies, especially in places where the healthcare territorial coverage is low.

Dialogues on the work process in oral health in Brazil: an analysis based on the PMAQ-AB survey

The study aimed to: (1) describe the work process in Brazil's oral health teams, based on the essential attributes of primary health care, according to geographic region, type of team, and the municipality's socioeconomic characteristics and (2) verify whether the data in the work process of the oral health teams in the Brazilian National Program to Improve Access and Quality in primary health (PMAQ-AB) were capable of measuring such attributes. This was a nationwide ecological study with data from cycle I of PMAQ-AB. The study included descriptive, exploratory factor, and confirmatory factor analyses (α = 5%). Constructs were analyzed in light of the essential attributes of primary health care (first contact, coordination of care, comprehensiveness, and continuity). The first three constructs and a fourth factor were formed, called dental prosthesis actions. However, the continuity attribute was not formed. The models' goodness-of-fit measures were satisfactory. Factor loads were greater than 0.5, except for the two variables in factor 3. The actions most frequently performed by the oral health teams (> 60%) were in first contact, and the least frequent were those in comprehensiveness, highlighting referrals to specialties (7.6%). There were differences in the work process in oral health teams between regions of the country, type of team, and certification strata (p < 0.05). In conclusion, data on the work process in oral health teams from cycle primary health care in the services' work routine. Further research is recommended on continuity of care. In addition, the oral health teams participating in cycle I of PMAQ-AB should make further progress in actions related to comprehensiveness and coordination of care.

Family Health Strategy associated with increased dental visitation among preschool children in Brazil.

Early-life dental service utilization could improve child dental health. Identify contextual, socioeconomic, and child characteristics associated with dental visitation by age 3 years. Within a Brazilian birth cohort (N = 435), multivariable regression models were fitted to identify independent predictors of having made a dental visit at age 3 years. Contextual variables considered included health center type (Traditional vs. Family Health Strategy, which perform home visits) and composition of oral health teams at the heath center where mothers accessed prenatal care. Dental visitation was positively associated with Family Health Strategy health centers (36% vs. 23%) and with higher maternal education and family social class. Visitation was lowest among families served by a health center without a dentist, but number of dentists and oral health team composition were not associated with visitation among facilities with ≥1 dentists. Dental visitation was not statistically significantly associated with caries experience but was higher if parents reported worse oral health-related quality of life. The vast majority of dental decay remained untreated. Dental visits were underutilized, and socioeconomic inequalities were evident. Dental visitation was more common when mothers received prenatal care at Family Health Strategy health centers, suggesting a possible oral health benefit.

A Survey About Dental Instruments at the Primary Health Care in Brazil.

This study describes the structure of oral health services in primary health care in Brazil and the instruments available for the provision of oral health care and to compare the number of instruments according to organizational characteristics of health services and among the macroregions. Of the 23,251 oral health teams (OHTs) in the Public Health System, 17,513 (75.3%) participated in this study. Trained researchers observed the structures of the health services and determined the presence of and whether a sufficient quantity of 36 dental instruments existed. The score of each oral health service was determined by the sum of the number of dental instruments present in sufficient quantity (0 to 36). Central tendency measures were compared along with the variability in these scores according to the organizational characteristics of the services and according to the Brazilian macroregion. No instrument was found to be present in all evaluated services. Basic, surgical and restorative instruments were the most frequently found. Periodontal, endodontic and prosthetic instruments exhibited the lowest percentages. The mean and median numbers of dental instruments were higher for teams that operated over more shifts, those with an oral health technician and those in the South and Southeast regions. The oral health services were equipped with basic, surgical and restorative instruments. Instruments designed for periodontal diagnosis, emergency care and denture rehabilitation were less frequently found in these services. The worst infrastructure conditions existed in the OHTs with the worst forms of care organization and in regions with greater social issues.

Tecnologias de informação e comunicação para formação profissional em Odontologia: uma proposta do Telessaúde/ES

O Telessaúde/ES, com o auxílio de Tecnologias de Informação e Comunicação (TIC), promove a ampliação da Educação Permanente à Saúde (EPS) aos profissionais atuantes nas equipes de Estratégia Saúde da Família (ESF) do estado do Espírito Santo. O presente estudo objetivou apresentar uma proposta de um ambiente virtual em Odontologia, no âmbito do Telessaúde/ES, proporcionando um espaço exclusivo de compartilhamento de informações às Equipes de Saúde Bucal (ESB). Trata-se de uma pesquisa-ação, método adequado para propor soluções para a melhoria do acesso e utilização das ferramentas do Telessaúde/ES pelas ESB mediante às necessidades identificadas. Em 2017, o Telessaúde Bucal iniciou suas atividades no Telessaúde/ES, disponibilizando os serviços de webpalestras, teleconsultorias assíncronas e síncronas e materiais oficiais da área, ofertados na última sexta-feira de cada mês. O ambiente virtual de Telessaúde Bucal apresentado estará incluso no espaço de “Programas Especiais”, permitindo o acesso a qualquer serviço. O Telessaúde Bucal é um serviço que poderá promover conhecimento e troca de experiências para a efetivação da EPS, estimulando maior participação dos profissionais da Odontologia.

Configuração da cobertura de saúde bucal brasileira e o acesso da população ao serviço público odontológico

O objetivo deste estudo foi analisar a cobertura de saúde bucal brasileira e o acesso da população ao serviço público odontológico entre os anos de 2008 e 2012. Trata-se de um estudo ecológico, comparativo-descritivo, por documentação indireta. As médias de Equipes de Saúde Bucal (ESB) do serviço público brasileiro variam de acordo com as regiões. No período avaliado, o Nordeste apresentou maior média de ESBs (64,0); seguido das regiões Sul (56,0); Centro-Oeste (53,0); Norte (44,0) e Sudeste (43,0). A região Nordeste concentra as maiores médias populacionais que nunca realizaram consulta odontológica, mas essa é a região que apresenta a maior oferta de serviço odontológico. As menores médias concentram-se no Sul, que após o Nordeste é a região com maior oferta de serviço público odontológico. Verificou-se diferença entre a proporção da população que nunca realizou consulta odontológica e a proporção da população com cobertura de plano de saúde (p=0,009). O acesso e a utilização dos serviços públicos de saúde bucal pela população brasileira, nas diferentes regiões geoeconômicas, bem como a quantidade de equipes de saúde bucal é desigual, havendo maior procura pela atenção em saúde bucal entre os usuários que possuem plano de saúde privado, que pertencem ao sexo feminino, e residem na área urbana.

Factors behind self-perceived need for dental treatment and prosthesis in Brazilian elderly people

The scope of this study was to identify individual and contextual factors associated with the self-perceived need for dental treatment and for prostheses among elderly Brazilians. An analysis was performed with data from the SB Brazil 2010 epidemiological survey conducted by the Ministry of Health with a sample of 7,619 elderly individuals. Multilevel logistic regression models of mixed random and fixed effects were used to the estimate odds ratio (OR) with 95% confidence interval (95% CI) between the dependent variables and individual and contextual factors. Of the individuals assessed, 3,848 (50.5%) reported a need for dental treatment and 4,236 (55.6%) believed they have the need for prostheses. The results of multilevel logistic regression showed that gender, self-reported skin color, income and coverage by the oral health teams in the Family Health Program were associated with self-perception. This study revealed a greater influence of individual factors on the self-perceived need for dental treatment and prostheses by elderly Brazilians. This information can help to identify the inequalities that affect this population group and in setting priorities for the planning of health services.

A visita domiciliar como prática pedagógica na formação em Odontologia

As Diretrizes da Política Nacional de Saúde Bucal destacam a visita domiciliar (VD) como uma das principais formas de ampliação do acesso aos serviços e criação de vínculo com a população, caracterizando-a como um desafio para as Equipe de Saúde Bucal. A adequação dos cursos de Odontologia às Diretrizes Curriculares Nacionais (DCN) implica em preparar o egresso para essa abordagem, utilizando a VD como estratégia pedagógica. Esse estudo investigou as contribuições da VD na formação odontológica, por meio de uma revisão integrativa da produção científica nacional, no período entre 2004 a 2017, compondo uma síntese qualitativa da literatura. Foram pesquisadas quatro bases de dados por meio dos descritores (“home care” OR “home visits”) AND (“dentistry” OR “oral health”). Nove estudos compuseram o corpo de análise desta revisão. Dos resultados emergiram quatro categorias: 1- Formação do cirurgião-dentista no Sistema Único de Saúde; 2- Compreensão ampliada do processo saúde-doença; 3- O trabalho interdisciplinar; 4- Humanização do Cuidado. Como contribuições à formação evidenciou-se que a VD propiciou ao estudante de Odontologia a vivência no território e a interação com usuários e profissionais da equipe de saúde. O contato do estudante com a VD possibilita o aprendizado do cuidado à saúde do usuário em seu contexto de vida, bem como a vivência do trabalho interdisciplinar, valorizando os diferentes saberes profissionais. O domicílio demonstrou-se como espaço singular para o aprendizado de vínculo, acolhimento e humanização, o que favorece a formação odontológica na perspectiva da clínica ampliada.

Availability of Dental Prosthesis Procedures in Brazilian Primary Health Care.

Objectives To describe dental prosthesis provision in the Brazilian public health service and report the performance of dental prosthesis procedures according to the Brazilian macroregions. Methods A structured interview was conducted with senior-level health professionals from each of the 18,114 oral health teams (OHT). The dependent variables were performance of removable prostheses and prosthesis procedures, including provision of fixed prostheses by OHT. Descriptive statistics were produced together with performing a cluster analysis using SPSS version 19.0. Results The manufacture of any type of prosthesis was done by a minority of OHT (43%). The most commonly provided types of dental prosthesis were removable full and partial dentures. Cluster 1 (teams that performed prosthesis procedures the most) was composed of a smaller number of teams (n = 5,531), and Cluster 2 (composed of teams that do not perform prosthetics or that perform them in small amounts) consisted of 12,583 teams. The geographic distribution of clusters reveals that the largest proportion of Cluster 1 teams is located in the Northeast (33.9%) and Southeast (33.6%). Conclusions A minority of OHT produce dental prostheses. There is an unequal geographical distribution of clusters.

Use and resolubility of the oral health public services offered to children in a large municipality

ABSTRACT Objective: To evaluate the effect of caries severity and socioeconomic conditions on use of oral health services and treatment situations (completed treatment, evasion, referral) among children with dental treatment needs, using the Unified Health System. Methods: Cross sectional study performed among children up to six years old, with dental treatment needs, coming from public schools in Belo Horizonte, Brazil, examined by the Oral Health Teams in the annual survey of oral health, in 2014. Variables were collected by consulting the medical records and information systems. Services were used by children who had attended the dental appointment at least once. The severity of caries considered the number of cavitated teeth. The socioeconomic variables were: age, sex, skin color and family socioeconomic classification. Resolubility was assessed by the ratio between completed treatment and first appointment. Evasion was defined by absence in more than two consecutive unjustified appointments. Association was tested by chi-square test and Poisson regression. Results: The frequency of services use was 44.3% and there was greater use by children with treatment needs in 4 to 8 teeth (PR=1.48, 1.23-1.78) and in more than 9 teeth (PR=1.80, 1.32-2.46) and lower in those with very high socioeconomic risk (PR = 0.79, 0.63-0.99). The resolubility was of 49.6% and 5.2% abandoned the treatment. Children with lower socioeconomic status presented lower resolubility and greater avoidance. Conclusion: The results suggested a persistent iniquity, with less use and resolubility of oral health services among children presenting worse socioeconomic status.

Oral Health in the Family Health Strategy: analysis of articles published in the period 2004-2014

This study aimed to conduct an integrative review of scientific literature on the topic of Oral Health in the Family Health Strategy in the period 2004-2014. Articles published in national and international journals (n = 141) were consulted and selected from the electronic Library the Scientific Electronic Library Online (SciELO) and from electronic databases PubMed, Lilacs, BBO and Cochrane. The implementation process of oral health teams in the Family Health Strategy was the most frequent thematic variable (18%) of the 15 variables identified. The Northeast was the Brazilian macro-region where the largest number of published articles originated (n = 61). The studies were predominantly quantitative, and the highest number of publications occurred in 2010 (n = 26). We concluded that there is an increasing interest in investigating the context of oral health implementation in the Family Health Strategy, with particular emphasis on theme categories related to the micro-process work and the redefinition of professional identities arising from multidisciplinary work in primary care.

Evaluation of Specialized Oral Health Procedures Performed in Brazil in the Period from 2008 to 2012

Objective: To analyze the correlations between the production of specialized dental procedures from 2008 to 2012 and factors related to the services and context of the Brazilian states. Material and Methods: A quantitative ecological-type study was developed, in which secondary data from Brazilian national databases were used. Procedures for outpatient production of specialized procedures throughout Brazil, from 2008 to 2012, were consolidated from the offering state, the state of the federation being the analysis unit. In order to collect data on coverage by oral health family teams in the Family Health Strategy, as well as the number of CEOs per state, the Strategic Support Management Room (SAGE) was accessed. The corresponding indicator mean proportion of specialized procedures in Brazil (Pmb) was used as dependent variable. Correlations were tested using Spearman's test. The software was Statistical Package for Social Sciences, v. 17.0, with a level of significance of 5%. Results: Pmb was 4.9% for the evaluated period. There was a negative correlation between indicator and the coverage of oral health teams in the family health strategy. Conclusion: The correlations analyzed were influenced by the organization and distribution of the professionals' workforce; revealing that the non-organization of the health care network may increase the performance of specialized procedures resulting from spontaneous demand due to the poor basic care coverage.

Integration of an Oral Health Team into a Student-Faculty Collaborative Clinic: Successes and Challenges.

Vulnerable populations are more likely to access medical care than visit a dentist. We introduced a dental team into a student-faculty collaborative clinic that serves a low-income Latino population. Documentation of oral exam findings rose from 11.88% to 50.50% in the year following integration of dental students into the clinic.

Secondary care in oral health in small municipalities: a cross-sectional evaluation of demand x access

ABSTRACT Objective: To know the demand and access to specialized procedures in Oral Health in 10 municipalities in the region of Guanhães, Minas Gerais, Brazil, which do not have a Dental Specialty Center. Methods: Cross-sectional study was conducted with 30 dental surgeons of the Primary Care system. These dentists recorded all the patients who were treated from July to November 2016, and who were shown to be in need of being assigned to specialized procedures in oral health. The descriptive analysis was developed in the software SPSS for Windows version 18.0. The study was approved by the Research Ethics Committee of the Federal University of Minas Gerais (ruling 1.615.701). Results: 1085 patients assigned for specialized procedures in Oral Health were evaluated. The majority of these patients were women (56.6%), within an age-range from 13-34 years (51.9%). Among the specialties evaluated, 61% of the patients presented the need for endodontic treatment, with the most compromised tooth being the first permanent molar (33.2%). The outcomes were recorded for 435 (40.1%) patients. Among these, 19.8% of the procedures were performed in the health unit itself and in 45.5% extractions were performed. Conclusion: Limited access to specialized Oral Health procedures was verified. To enable the Oral Health National Policy to consider the specificities of such regions, it is suggested that the scope of action of the oral health teams in primary care is expanded, or that less expensive specialized services are created, so that the access to this level of oral health is assured to all referred patients.

Dental Procedures in Primary Health Care of the Brazilian National Health System.

The aim of this study was to examine the procedures of primary dental health care performed by oral health teams (OHTs) adhering to the second cycle of the ‘National Programme for Improving Access and Quality of Primary Care’ (PMAQ-AB) in Brazil. A cross-sectional descriptive analysis was performed, across 23 dental procedures comprising preventive, restorative/prosthetic, surgical, endodontic and oral cancer monitoring. Descriptive analysis shows that most of the oral health teams carry out basic dental procedures. However, most of the time, they do not keep adequate records of suspected cases of oral cancer, diagnosis tests or follow-ups, and do not perform dental prosthetic procedures. Data also showed disparities in the average number of procedures performed in each Brazilian geographical region in 2013–2014, ranging from 13.9 in the northern to 16.5 in the southern and south-eastern regions, reinforcing the great social disparities between them. Brazilian regions with the highest volume of dental need deliver the lowest number of dental procedures. The need to tackle inequalities and further shape the supply of appropriate primary health care (PHC) is evident.

Work process of an oral health team according to the dentists

ABSTRACT Objective: The aim of this study, conducted with the participation of the dentists of public service of Campinas, Dental Hygienist Technicians (TSBs) and Oral Health Assistants (ASBs), was to investigate the adequacy of the work process relative to the legal duties and professional limits. Methods: All the 180 dentists linked to the public service in 2014 were invited to take part in the study. Structured and self-administered questionnaires were sent to the these professional and they focused on vocational training and the allocation of functions in routine health care based on the provision of Law 11.889/2008. Results: Considering the respondents, the post-graduation period was 22.1 ± 7.4 years and they had a mean number 16.2 ± 8.9 years of public service. The majority of dentists worked with assistants (82.8%) during the period of study. Regarding the functions delegated to assistants, of the 36 functions identified, it was noted that 14 (38.9%) of the functions delegated diverged from their legal attributes, for most respondents; of these 35.7% (5) denoted extrapolation of ASBs functions, 28.6% (4) extrapolation of TSBs functions and 35.7% (5) underutilization of assistants, in particular TSBs. Conclusion: The authors concluded that most actions were being delegated in a manner consistent with the legal provisions, however, there were still situations of extrapolation of assistant's functions and underutilization of TSBs.

Factors associated with patients' satisfaction in Brazilian dental primary health care.

ObjectiveTo assess factors associated with patients’ satisfaction with the treatment by dentists in primary health care (PHC) in Brazil.Materials and methodsThe dataset was part of a nationwide cross-sectional survey for evaluating PHC teams conducted by the Brazilian Ministry of Health. Patients from each of 16,202 oral health teams were interviewed. In addition to sociodemographic information, the questionnaire included information about patient experience domains: access and booking of dental appointments, bonding and accountability, welcoming of the patient, and their perception of dental facilities.Statistical analysisThe dependent variable was the answer to the question ‘From 0 to 10, how would you grade your satisfaction with treatment received from the dentist?’ Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios and corresponding 95% confidence interval.ResultsThe mean patient satisfaction was 9.4 (±2.3). Higher patient satisfaction with PHC was associated with lower education and the patient’s perception of the clinic conditions. Moreover, higher satisfaction was associated with positive reception and hospitality, enough time for treatment, and instructions that met patients’ needs. Lower satisfaction with PHC was associated with patients who have jobs compared to those who do not work.ConclusionPatient satisfaction is increased with friendly and understanding PHC staff. Moreover, meeting patient expectations by taking time to understand the needs and giving the right instructions is associated with higher satisfaction.