Dissertationen zum Thema „Dental care Evaluation“

The Shirley Glasstone Hughes Trust Fund (SGHTF) instigated a research agenda-setting process to ensure its primary research commissioning was targeted at the topics of most relevance to primary dental care practitioners. Overall, the objective was to reduce barriers to evidence-based dentistry practice. A web-based system generated research topic nominations, and a resource- constrained rapid evidence review process produced Evidence Summaries for use by practitioners and research commissioners, launched in May 2009. Nine Evidence Summaries were published in the British Dental Journal, and SGHTF used these outputs to inform research commissioning. This health services mixed methods research aimed to evaluate the implementation of the SGHTF research agenda-setting process. Feasibility and effectiveness of setting up and running the web-based system, and implementation of the newly-designed rapid review process was assessed using a range of component studies: semi-structured interviews with research commissioners; quantitative and qualitative assessment of the reviewer's activity diaries; quantitative assessment of dental practitioners' research topic nominations and voting (online topic prioritisation); postal surveys (as part of the British Dental Association's national Omnibus Surveys) to dentists, and an e- survey to research commissioners to assess usefulness and relevance of research topics generated and rapid reviews completed. The findings showed that both the web-based system and the rapid review process were feasible. However, levels of engagement with the former by dentists were modest, due to the implementation approach. Evidence Summaries were found to be of relevance and useful to practitioners and research commissioners. Similar organisations seeking to enhance evidence-based practice are encouraged to draw upon relevant expertise at an early stage in planning new initiatives. Full appreciation of what communication is possible through online means, how it fits into their mission overall, and what is involved, is required at the outset to achieve successful on line stakeholder relationship building.

Significant efforts have been undertaken in medicine to identify hospital and primary care service areas (eg, the Dartmouth Atlas of Health Care) using patient origin information. Similar research in dentistry is nonexistent. The goal of this dissertation was to develop and refine methods of defining dentist service areas (DSAs) using dental insurance claims. These service areas were then used as spatial units of analysis in studies that examined relationships between utilization of oral health services, dentist workforce supply, and service area characteristics. Enrollment and claims data were obtained from the Iowa Medicaid program for children and adolescents ages 3-18 years during calendar years 2008 through 2010. The first study described rates of treatment by orthodontists in children ages 6-18 years. Orthodontic DSAs were identified by small area analysis in order to examine regional variability in utilization. The overall rate of utilization was approximately 3%; 19 DSAs were delineated. Interestingly, children living in small towns and rural areas were significantly more likely to have received orthodontic services than those living in metropolitan and micropolitan areas. The second study identified 113 DSAs using claims submitted by primary care dentists (ie, general and pediatric dentists). Characteristics of these primary care DSAs were then compared with counties. Localization of care was used as a measure of how well each region approximated a dental market area. Approximately 59% of care received by Medicaid-enrolled children took place within their assigned service area versus 52% of care within their county of residence. Hierarchical logistic regression was used in the final study to examine the influence of spatial accessibility and the importance of place on the receipt of preventive dental visits among Medicaid-enrolled children. Children living in urban areas were more likely to have received a visit than those living in more rural areas. Spatial accessibility assessed using measures of dentist workforce supply and travel cost did not appear to be a major barrier to care in this population. More studies are needed to explore the importance of spatial accessibility and other geographic barriers on access to oral health services. The methods used in this dissertation to identify service areas can be applied to other populations and offer an appropriate method for examining revealed patient preferences for oral health care.

Electronic Dental Records (EDR) are an important part of dental care in Sweden. The usability of these records can affect the workflow in dental care organizations. This study aims to measure the System usability scale (SUS) score of EDRs that are used in dental clinics in Sweden. The study will also investigate the relationship between the SUS score of EDRs and participants’ age, gender, interest in technology, number of patients per workday, professional experience, possible special training to use the EDR, and the period of the training. The study will also rank the most common usability problem in EDRs among the seven possible usability problems included in the questionnaire. The study will present how the participants describe experienced usability problems in the EDRs. The quantitative method constitutes the largest part of this study, while the open-ended questions were used to get a deeper knowledge about some of the usability problems. A digital questionnaire was used in this study to gather data from 115 dentists and 77 dental hygienists who work at various dental clinics around Sweden to get a statistical anchored description about the usability of various EDRs. SUS indicates a low usability level in the EDRs included in the study and a significant negative correlation between the frequency of using EDRs and usability. The males showed better experience with the usability of the EDRs compared to females. The highest-ranked usability problem was the need for users to spend a long time to document patient cases. The usability problems were summarized into three categories which are: an inefficient user interface, lack of semantic interoperability, and users relying on paper.
Elektroniska journalsystem är en viktig del av tandvården i Sverige, då användbarheten av dessa system kan påverka arbetsflödet i tandvårdsorganisationer. Denna studie syftar till att mäta System usability scale (SUS) poäng för olika elektroniska journalsystem som används i olika tandkliniker i Sverige. Studien kommer också att undersöka sambandet mellan SUS-poäng för elektroniska journalsystem och deltagarnas ålder, kön, intresse av teknologi, antal patienter per arbetsdag, yrkeserfarenhet, möjlig specialutbildning för att använda elektroniska journalsystem och perioden för denna utbildning. Studien kommer också att rangordna det vanligaste användbarhetsproblemet i journalsystem bland de sju möjliga användbarhetsproblemen som ingår i frågeformuläret. Studien kommer att presentera hur deltagarna beskriver upplevda användbarhetsproblem i journalsystem. Den kvantitativa metoden utgör den största delen av denna studie, medan de öppna frågorna användes för att få en djupare kunskap om några av användbarhetsproblemen. Ett digitalt frågeformulär användes i denna studie för att samla in data från 115 tandläkare och 77 tandhygienister som arbetar vid olika tandkliniker runt om i Sverige för att få en statistisk förankrad beskrivning om användbarheten av olika elektroniska journalsystem. SUS indikerar en låg användbarhetsnivå i de systemen som ingår i studien. Vi upptäckte också en signifikant negativ korrelation mellan frekvensen av att använda systemen och användbarhetsnivån. Män visade en bättre upplevelse för användbarhet av systemen jämfört med kvinnor. Det högst rankade användbarhetsproblemet var användarnas behov av lång tid för att dokumentera patientfall. Vi sammanfattade hur deltagarna beskriver upplevda användbarhetsproblem i journalsystem under tre kategorier som är: ett ineffektivt användargränssnitt, brist på semantisk interoperabilitet och användare som skriver på en lapp.

Adults with developmental disabilities that live in large residential settings experience complications due to problem behavior when attending routine medical/dental appointments. This may result in sedation for clients for even the most routine medical/dental appointments. The purpose of this project was to develop a comprehensive staff training program that incorporated best practices to teach direct-support professionals behavior management techniques and best practices for transporting clients to and from routine medical/dental appointments. 4 direct-support professionals at a large residential care facility participated in this project. Multiple probes were conducted utilizing standard role-play exercises to evaluate caregiver acquisition of 16 specific skills related to client information, best practices for client transport, and behavior management. The results indicated that behavior skills training (BST) resulted in caregiver acquisition of all 16 skills during role-play exercises.

This research project explored the use of reflective practice by a Bachelor of Science (BSc) cohort in a United Kingdom (U.K.) dental training establishment following the publication of Preparing for Practice by the General Dental Council (GDC) in 2012, which identified the Learning Outcomes for the Dental Team registration in the U.K. The research reviewed the evolving role that professional reflective practice has in student education by capturing students’ experiences as they transitioned through the preclinical (simulated) aspects of their programme and onto their final year when they actively treat patients on the clinical floor and in various outreach locations. The final aspect moved away from the educational arena, focussing on the realms of GDC Fitness to Practice cases. Thus adding an element of context and meaning to the realities of professional reflection in the real world, highlighting the potential consequences of failing to nurture future professional reflective practice activities as a GDC registrant. An aspect which is particularly pertinent with the advent of Enhanced CPD on the horizon in 2018. The drivers for reflective practice to occur is twofold; with an onus on the need of personal development and insight, alongside the broader pre-requisites from formal educational bodies and statutory regulatory authorities. These authorities may well favour the benefits that reflective practice brings by facilitating a shift of responsibility, away from educational decision makers, onto the registrant to self-manage and develop their own awareness. Meeting both of these aspects is feasible, providing that the registrants have the skills, support, time and a clear understanding (definition) of the term professional reflective practice and what this should mean to them in the context of their professional practice. The research findings demonstrate that the main role of reflective practice in primary dental care settings is to gain insight by facilitating pondering, thinking, discussion or asking questions (of oneself or one another). By reviewing the positive and negative experiences that they had encountered, students were then able to work things out (making sense of things), in turn, allowing them to learn from experience and therefore implement meaningful development opportunities for the future.

Objective: The aim of the study was to evaluate the clinical outcomes of oral implant treatment provided at the School of Dentistry, University of Otago from 1989 to 2005. Methods: Oral implant patients (n=320) with 586 implants were identified and invited to attend for a clinical examination. Implant demographics of all the patients were extracted from the files. Implant demographics of the examined and unexamined patients were compared to assess if the examined patients were representative of the total group. One hundred and three patients with 214 implants agreed to attend for an examination. In the clinical examination full mouth plaque scores, probing depths, bleeding on probing and suppuration were measured. In addition, around implants recession and width of keratinized gingiva were also recorded. For the radiographic examination, baseline radiographs and radiographs taken at the time of examination were digitized and compared to measure the amount of bone lost or gained around implants using NIH Image J software. Results: There were equal numbers of males and females with a mean age of 46.3 � 15 years at the time of implant placement. The smoking history at the time of examination was recorded, 56% of the patients were non-smokers, 37% former smokers, and 7% were current smokers. More than half of the implants (56%) were placed in the anterior region. Based on the type of implant system, 79% were Branemark implants, 10% Straumann, 6% Southern implants and 4% were unknown. Most of the patients (64%) had implant-supported crowns, 19% had fixed denture prostheses, and 17% had implant-supported overdentures. The overall implant survival rate was 97.7% with five implants lost (2.3%) and 8 implants treated for peri-implantitis (3.8%). The mean PD around implants was 2.3mm (SD 0.6mm), mean recession was 0.5mm (SD 0.8mm) and mean attachment level of 2.8mm (SD 0.9mm). Probing depths [greater than or equal to] 4mm with BOP were recorded around implants in 8.9% of patients. The mean full mouth plaque score was 30% while mean plaque score around implants was 15.9%. The average bone loss around implants was 0.3mm (SD 0.8). Maximum bone loss observed was 2.9 mm. Conclusion: The prevalence of peri-implant inflammation and implant survival rates in this group of patients appeared comparable to that reported in the literature. The prevalence of peri-implant lesions was low in the group of patients examined.

Quality assurance in healthcare is fundamental in ensuring the achievement of desired outcomes for patients. In 2011 a quality assurance plan was created at the East Tennessee State University (ETSU) dental hygiene program in order to meet accreditation standards. The purpose of this study was to evaluate this plan in order to determine its effectiveness in improving the quality of patient care indicators. One hundred fifty patient charts were selected and audited. Deficiencies were counted in the categories of assessment, treatment, documentation, referral, caries management, perio management, patient education, and follow-up. Research findings were varied; however, external variables with the potential to affect the study’s results were identified. Furthermore, statistical process control procedures indicated that the quality assurance program was effective or had the potential to be effective. Although further research is warranted, this study could be used to improve quality assurance practices at the ETSU dental hygiene program.

O perfil epidemiológico da população idosa brasileira evidencia um quadro de extensas perdas dentárias e problemas de saúde bucal. A fim de reverter este quadro, observa-se o desenvolvimento de diversas políticas públicas de saúde cujo objetivo está em garantir atenção integral à saúde da população idosa, com ênfase no envelhecimento saudável e ativo. Porém, no que diz respeito aos Serviços de Saúde Bucal, poucos estudos têm sido desenvolvidos na ambição de conhecer a satisfação deste grupo etário com tais serviços. O objetivo deste estudo foi investigar a associação entre a resiliência e a satisfação com os Serviços Odontológicos, levando em consideração variáveis exógenas, determinantes primários, comportamentos e condições de saúde. Investigou-se a hipótese de que a resiliência está associada à satisfação com os Serviços Odontológicos acessados pelos idosos. O lócus da pesquisa foi a gerência distrital Lomba-Partenon, em Porto Alegre – RS, onde 771 idosos foram identificados em seus domicílios por meio de amostragem por conglomerado. Os indivíduos responderam a um questionário sócio-demográfico e de comportamentos em saúde, à Escala de Resiliência e a questões relativas ao Serviço Odontológico acessado e à satisfação com o mesmo; além disso, foi realizado um breve exame bucal para contagem do número de dentes e identificação do uso de prótese dentária. Baseado em uma abordagem hierárquica realizada através de Regressão Logística Multivariada, as odds ratios estimadas das variáveis que ficaram significativamente associadas com o desfecho em estudo, satisfação com o Serviço Odontológico, após a análise totalmente ajustada, foram: 1) obtenção de consulta odontológica classificada como regular: OR= 1,85, 95% IC (1,10 a 3,12); 2) obtenção de consulta odontológica classificada como ruim: OR= 2,17, 95% IC (1,05 a 4,50) e 3) alto potencial de resiliência: OR= 0,60, 95% IC (0,37 a 0,97). Portanto, os resultados confirmam a hipótese de associação entre elevado potencial de resiliência e satisfação com os Serviços Odontológicos acessados por idosos.
The epidemiological profile of the elderly population shows a picture of extensive tooth loss and oral health problems. In order to reverse this situation, there is the development of various public health policies whose aim is to ensure comprehensive health care of the elderly population, with an emphasis on healthy aging and active. However, with regard to Dental Health Services, few studies have been developed to meet the satisfaction of this age group with such services. The objective of this study was to investigate the association between satisfaction with the resilience and Dental Services, taking into account exogenous variables, the primary determinants, behaviors and health conditions. It was investigated the hypothesis that resilience is associated with satisfaction with dental services accessed by older people. The locus of this research was the district management Lomba-Partenon, in Porto Alegre – RS, where 771 seniors were identified in their homes through cluster sampling. The subjects answered a questionnaire for socio-demographic and health behaviors, Resilience Scale and questions regarding the dental care accessed and satisfaction with it. In addition, there was a brief oral examination to count the number of teeth and identify the use of dental prosthesis. Based on a hierarchical approach performed by multivariate logistic regression, the estimated odds ratios of variables that were significantly associated with the outcome under study, satisfaction with dental care services, fully adjusted after analysis, where: 1) obtaining a dental visit classified as regular: OR= 1,85, 95% IC (1,10 a 3,12); 2) obtaining a dental visit classified as bad: OR= 2,17, 95% IC (1,05 a 4,50) and 3) high potential for resilience: OR= 0,60, 95% I C (0,37 a 0,97). Therefore, the results confirm the hypothesis of an association between high potential for resilience and satisfaction with dental services accessed by older people.

Orientadores: Stela Márcia Pereira, Gláucia Maria Bovi Ambrosano
Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Este estudo seccional investigou o impacto dos Centros de Especialidades Odontológicas (CEOs) nos indicadores de procedimentos da atenção secundária no Estado de São Paulo, bem como sua relação com variáveis econômicas. A amostra contou com os 645 municípios do estado, divididos segundo a presença e ausência dos CEOs, no ano de 2009. As variáveis dependentes analisadas foram os procedimentos de endodontia, periodontia e cirurgia oral menor e as variáveis independentes selecionadas foram cobertura dos Centros de Especialidades, renda per capita e PIB per capita. A análise estatística dos dados foi feita através de teste Qui-quadrado e regressão logística múltipla, ajustada para a co-variável porte municipal. Como resultado, observou-se que os municípios que têm CEO apresentaram um maior número de procedimentos quando comparados aos que não o possuem (p<0,0001). A presença do CEO (p=0,0001; OR:49,06); (p<0,0001; OR:9,59); (p<0,0001; OR:26,39) foi considerada determinante para o maior número de procedimentos clínicos de Endodontia, Periodontia e Cirurgia Oral Menor, respectivamente. Pode-se concluir que os Centros de Especialidades Odontológicas impactaram, de forma substancial, o acesso aos serviços de atenção secundária no estado de São Paulo, independente do porte municipal
Abstract: This cross-sectional study investigated the impact of Specialized Dental Clinics (SDC) on indicators of secondary care procedures in the state of São Paulo, as well as its relation to economic variables. The sample consisted of the 645 municipalities in the state, with and without SDC in 2009. The dependent variables analyzed were endodontics, periodontics and minor oral surgery procedures and independent variables selected were specialized coverage, per capita income and per capita GDP. The statistical analysis was performed using chi-square test and multiple logistic regression, adjusted for covariate municipal size. Results showed that counties with SDC presented greater number of procedures when compared with those who do not have (p <0.0001). The presence of the SDC (p = 0.0001, OR = 49.06) (p <0.0001, OR: 9.59), (p <0.0001, OR: 26.39) was considered decisive for the largest number of clinical procedures of Endodontics, Periodontics and Minor Oral Surgery, respectively. In conclusion, Specialized Dental Clinics impacted access to secondary care services in the state of São Paulo, regardless of municipal size
Mestrado
Odontologia em Saude Coletiva
Mestra em Odontologia em Saúde Coletiva

Os sistemas de saúde são respostas a demandas das sociedades, devendo ser articulados pelas necessidades de saúde. A Saúde Bucal está inserida no programa de Saúde da Família desde o ano 2000, porém foi em 2004, com o lançamento da Política Nacional de Saúde Bucal, que ocorreu uma reorganização dos serviços em todos os níveis de atenção, com ampliação e qualificação da Atenção Básica e implantação da Atenção Especializada. Considerando que houve uma forte expansão no acesso aos serviços de saúde bucal, é de fundamental importância estudar a relação presente entre estes dois serviços. Os objetivos deste estudo foram verificar a prevalência da presença de interface entre a Atenção Básica (AB) e os Centros de Especialidades Odontológicas (CEO) no Brasil, de acordo o Programa de Melhoria do Acesso e da Qualidade, e avaliar se esta interface está relacionada à características do contexto municipal e variáveis dos serviços. Trata-se de um estudo multinível de abrangência nacional, do qual participaram os 927 CEO. A avaliação externa foi realizada em 2014 com um instrumento padronizado. O estudo contou com duas variáveis dependentes que refletiam a existência de interface entre AB e CEO - interface mínima e interface abrangente, com presença de protocolos, referência e contrarreferência. Os aspectos sociodemográficos incluíram as macrorregião, IDH-M e cobertura municipal de ESB. As variáveis do serviço envolveram planejamento, acesso e matriciamento. Foram realizadas análises das frequências absolutas e relativas, regressão de Poisson Multinível para obtenção das razões de prevalências brutas e ajustadas com intervalos de confiança de 95% e nível de significância de 5%, com o software Stata 11. A modelagem utilizada foi hierárquica em dois estágios. Para análise de ajuste dos modelos foram utilizados os parâmetros deviance, AIC e BIC. 52,53% (IC 95% 49,31-55,75) dos CEO apresentavam a interface mínima e 34,51% (IC 95% 31,45- 37,58) interface abrangente. Na análise ajustada em ambos os desfechos, as regiões Sul e Sudeste apresentaram maior prevalência do desfecho que a região Norte e o mesmo ocorreu para a faixa de IDH mais elevado. As equipes que realizaram planejamento nos últimos 12 meses tiveram uma probabilidade 60% maior de apresentar uma interface mínima, sendo que o matriciamento aumentou essa probabilidade em 30% e o acesso exclusivamente agendado em 31%. Estes resultados se assemelham na interface abrangente. A relação entre a AB e os CEO traduzida na interface implica na produção de cuidados mais equânimes, integrais, eficientes e efetivos, o que está de acordo com os princípios do SUS. Com os achados deste estudo, ficam evidenciadas as desigualdades existentes entre os serviços de saúde, demonstrando que ainda há muito o que investir na qualificação da gestão e formação destes serviços. Apesar de a Rede de Atenção à Saúde Bucal estar melhor estruturada ainda há muito o que avançar.
Health systems are the answers to social demands and must be articulated by health needs. Oral Health has been inserted in Family Health program in 2000, but in 2004, with the National Oral Health Policy, there was a reorganization of services at all levels of health care, with the extension and qualification of Primary Care and implementation of Specialized Attention. The strong expansion inthe access to oral health services demands studies about the relationship between the Primary Care and Specialized Dental Services. This study aimed to verify the prevalence of the interface between a Primary Health Care(PHC) and Specialized Dental Care(SDC) in Brazil, using data of the Program of Improvement of Access and Quality of SDC, and to evaluate if this interface isrelated to the municipal context and variablesrelated tothe services. This was a multi-level study of national scope including 927 municipal SDC. An external evaluation was carried out in 2014 through the application of a standardized instrument. The study had two dependent variables that reflected the interface between PHC and SDC - minimal interface and comprehensive interface. The sociodemographic aspects included the variables: macro-region, HDI-M and municipal Primary Care Dentistrycoverage. Service variables included planning, access and matrix support. Absolute and relative frequency analyzes and multi-level Poisson regression were performed to obtain prevalence raw ratios and adjusted with 95% confidence intervals and significance level of 5% (software Stata 11 ©). The modeling was hierarchical in two stages.There were used the deviance parametersfor adjustment analysis of the models, AIC and BIC. 52.53% (95% CI 49.31- 55.75) of the SDC presented a positive endpoint for the minimal interface and 34.51% (95% CI 31,45-37,58) for the comprehensive interface.The adjusted analysis shown that in both outcomes South and Southeast regions presented higher prevalence than theNorth region .The relationship between PHC and CEO,as represented by the interface, may lead to more equitable, comprehensive, efficient and effective care, in acordance with SUS principles. In conclusion, inequalities in dental health services are evidenced, showing that there is still much to invest in qualification of the management of these services.

O objetivo deste estudo foi identificar os principais avanços e desafios ocorridos na atenção à saúde bucal na Rede Regionalizada de Atenção à Saúde 13 (RRAS 13), sob a perspectiva da integralidade do cuidado, por meio de dois estudos transversais. O Estudo 1, ecológico, contou com dois momentos: o primeiro se valeu do banco de dados proveniente do instrumento de coleta das Avaliações Externas das equipes dessa região, participantes do 1º e/ou 2º ciclo do Programa de Melhoria do Acesso e da Qualidade (PMAQ-AB). O segundo momento abrangeu os indicadores de atenção básica de saúde bucal da região, propostos no Contrato Organizativo de Ação Pública (2013-2015) e os pactuados para o monitoramento do 1º e 2º ciclo do PMAQ-AB, obtidos nos bancos do Departamento de Informática do Sistema Único de Saúde. O Estudo 2, tipo survey, teve como instrumento de pesquisa um questionário aplicado aos cirurgiões-dentistas que integram as ESB da região em estudo que participaram do 1º e/ou 2º ciclo do PMAQ-AB. Os resultados mostram que as unidades de saúde com equipes de saúde bucal da RRAS 13, possuem, de forma geral, consultórios odontológicos com características estruturais e ambiência adequadas aos padrões estabelecidos pelo programa, bem como equipamentos, instrumentais e insumos suficientes para a realização de atividades clínicas, exceto os relacionados à confecção de próteses dentárias e RX. As equipes de saúde bucal realizavam a maior parte dos procedimentos para o atendimento clínico de saúde bucal, com exceção da reabilitação protética, que permanece principalmente inserida nos serviços especializados e pouco acessível aos usuários. Apesar dos avanços, foram identificadas barreiras no acesso dos usuários e a necessidade de expansão e fortalecimento das ESB, extensão do horário de funcionamento, bem como da reorganização das práticas no que se refere ao trabalho em equipe, apoio da gestão, planejamento das ações, atividades de educação permanente, matriciamento e realização de visitas domiciliares. Fragilidades no fluxo e o longo tempo de espera para atendimento especializado evidenciam a necessidade de estruturação da rede de atenção e fortalecimento da AB como coordenadora do cuidado, na busca pela integralidade do cuidado. O interesse dos cirurgiões-dentistas nesse processo se reflete na alta taxa de retorno dos questionários e na perspectiva positiva, de modo geral, em relação a proposta avaliativa do programa federal. Com os avanços e desafios mostrados nesse estudo, na sua singularidade, espera-se contribuir para o fortalecimento e consolidação da Política Nacional de Saúde Bucal no âmbito do Sistema Único de Saúde e para que o PMAQ-AB cumpra com sua função indutora no sentido de ampliar o acesso e a qualidade das ações de saúde bucal desenvolvidas nesta região, na perspectiva da construção de uma cultura avaliativa, ainda incipiente na área da saúde em nosso país
The aim of this study was to identify the main advances and challenges in oral health care in the Regional Health Care Network 13, from the perspective of comprehensive care, through two cross-sectional studies. Study 1, is a ecological study, which was divided into two sections: the first used the database of the External Evaluation instrument of health teams of this region that participated of the 1st and/or 2nd cycle of the Brazilian National Program for Improving Access and Quality of Primary Care. The second section covered the indicators of basic oral health care of this regions proposed in the Organizational Contract of Public and Health Action (COAP 2013-2015) and those agreed for the monitoring of the 1st and 2nd cycle of the PMAQ-AB obtained in the database of the Brazilian National Health System iformation system. Study 2, is a survey study, had as a research instrument a questionnaire applied to generalist dental surgeon that integrate the health team of the study region that participated in the 1st and / or 2nd cycle of PMAQ-AB. It was identified that the oral health units of RRAS 13 generally have dental offices with structural characteristics and ambience adequate to the standards established by the program, as well as sufficient equipment, instruments and supplies to carry out clinical activities, except those for dental prostheses and RX. Oral health teams performed most of the procedures for clinical oral health care, except for prosthetic rehabilitation, possibly due the permanence os this servisse in secondary care and not accessible to users. Despite the advances, barriers were identified in the access of users and the need to expand and strengthen of the oral health teams, extension of working hours, as well as the reorganization of the practices regarding teamwork, management support, action planning, activities of permanent education, specialist orientation and home visits. Fragilities in the interactions between first and secondary care as the long waiting time for specialized care point out that advances in access and coverage by oral health services are still necessary for structuring the care network and strengthening Primary Health Care as a care coordinator, in the search for integral care. The interest of generalist dental surgeon in this process is reflected in the high rate of return of the questionnaires and in the positive perspective, in general, in relation to the evaluative proposal of the federal program. With the advances and challenges shown in this study, in its singularity, it is hoped to contribute to the strengthening and consolidation of the National Oral Health Policy within the Brazilian Unified Health System and for PMAQ-AB to fulfill its inductive function in the sense of to increase the access and quality of the public oral health actions developed in this region, in the perspective of the construction of an evaluative culture, still incipient in the health area in Brazil

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Por meio do presente estudo, objetivou-se analisar a implantação do serviço de atenção à saúde bucal no município de Manaus. Para tanto, procedeu-se a uma pesquisa avaliativa do tipo análise de implantação abordando os determinantes contextuais do grau de implantação do serviço de atenção à saúde bucal, incorporando a avaliação normativa nas dimensões estrutura e processo. A estratégia utilizada foi o estudo de caso único, em que os materiais foram coletados de fontes primárias, por meio de questionário estruturado e entrevista com roteiro semiestruturado (sujeitos da gestão municipal e unidades de saúde), de observação da rotina dos diferentes tipos de Estabelecimentos Assistenciais de Saúde (EAS) e de fontes secundárias. Foram definidas 59 EAS, com base na proporção de unidades instaladas em cada distrito de saúde, e foram realizadas 106 entrevistas. Os indicadores utilizados para medir o grau de implantação em relação à estrutura foram: instalação física, equipamentos odontológicos, manutenção dos equipamentos odontológicos, instrumentais permanentes, materiais de consumo, materiais educativos e recursos humanos, pontuados com escore 0 ou 1. A pontuação recebida entre o observado e o esperado foi dividida, obtendo-se uma pontuação por indicador, por unidade de saúde, até chegar-se a um valor global. A classificação proposta foi a de quartis , em que o grau de implantação foi considerado satisfatório com valores acima de 75 por cento; aceitável, entre 50 por cento e 75 por cento; regular, entre 25 por cento e 49 por cento; e crítico, abaixo de 25 por cento. O grau de implantação do serviço de atenção à saúde bucal, em relação à dimensão estrutura (dados primários) foi considerado regular, alcançando um valor de 41,18 por cento. Os resultados gerados a partir da coleta dos dados secundários para compor as dimensões estrutura e processo, foram analisados de acordo com os parâmetros vigentes do MS e com as pactuações do município, não recebendo uma classificação quantitativa. Pelos dados observados, pode-se sugerir que os instrumentos de gestão existem para cumprir uma exigência legal e não para o exercício de uma adequada gerência do serviço de saúde bucal, assim como os indicadores do pacto de 2005 a 2007 e as ações de saúde bucal informadas no SIAB e SIA-SUS em relação aos procedimentos da atenção básica e especializada, mostraram estar aquém do que foi pactuado e da real necessidade da população manauara. O contexto organizacional local apresentou relação com o grau de implantação do serviço de atenção à saúde bucal, tendo como consequência a efetivação de práticas do modelo hegemônico, não condizentes com a política atual de saúde bucal.
The present study aimed to analyze the implementation of an oral health service in the municipality of Manaus. An evaluation research was carried, in the form of implementation analysis, involving contextual determiners of the rate of implementation of the oral health service, incorporating normative analysis of the dimensions “structure” and “process”. The strategy used was the single-case study, where the materials were collected from primary sources through a structured questionnaire and interview with semi-structured script (with subjects from the municipality management and health units), from routine observation of the different types of Assistance Health Establishments (EAS) and secondary sources. Fifty-nine EAS were defined based on the ratio of installed unit in each health district, and 106 interviews were carried on. The indicators used to measure the rate of implementation related to structure were: physical installation, dental equipments, maintenance of dental equipments, permanent instruments, consumer goods, educational materials and human resources, scored 0 or 1. The scores received between what was observed and what was expected was divided, thus obtaining one grade per indicator per health unit, until a global score was reached. The classification proposed was of “quartiles”, where the grade of implementation with values above 75% were considered satisfactory, between 50% and 75% were considered acceptable, between 25% and 49%, regular, and lower than 25%, critical. The rate of implementation of oral health service compared to the dimension “structure” (primary data) was considered regular, reaching 41.18%. The results obtained from secondary data collection to compose the dimensions “structure” and “process”, analyzed according to the parameters proposed by the Health Ministry and obliged by the municipality did not receive a quantitative score. By the data observed it can be suggested that management instruments exist in order to comply a legal exigency and not for the exercise an adequate management of the oral health service, similarly to the indicators of the 2005 and 2007 pacts and oral health actions informed at SIAB and SIA-SUS regarding procedures of basic and specialized attention, which proved to be short of those complied and the real needs of the population of Manaus. The local organizational context presented relationship to the rate of implementation of oral health services, with effectuation of practices from the hegemonic model as consequence, which are not in accordance to the present policy of oral health.

INTRODUCTION: Despite improvements in prevention, treatment modalities, and access of dental care, dental caries is considered one of the most common diseases among children worldwide. Significant disparities in the prevalence of dental caries and other oral health problems continues to exist by race ethnic groups and by socio-economic status. Another factor that influences the prevalence is the physical and mental status of children; this is attributed to the limitation of awareness, dexterity, and access to care among children with special health care needs. Overall improving the access to care, incorporating team-based practice and interprofessional collaboration are vital to improve and maintain oral and systemic health among children. OBJECTIVE: The objective of this study is to assess the team-based practice in the Pediatric Oral Healthcare Center (POHC) at Boston University School of Dental Medicine. MATERIALS AND METHODS: Different parameters were evaluated including dental procedures and patients’ outcomes; screening by non-dental specialists; feasibility and sustainability of team-clinics; retreatment of dental procedures within two years of follow-up; health care providers’ and administrative perception towards interprofessional collaboration. RESULTS: Children with special healthcare needs represented 13% of the total patients, with the majority under 6 and over 12 years old between 2017-2019. Sixty-five patients were evaluated by a Speech and Language Pathologist (SLP) and 42 were referred for further evaluation. The RDN evaluated 172 children with 50 children having abnormal BMI, and the majority were overweight or obese. Multidisciplinary treatment approach involving SLP and RDN in a pediatric dental clinic can provide an overall net revenue as high as $25,681.20 monthly. During follow-up, only 9% of the cases required retreatment; age was a significant factor with older children being less likely to require retreatment. High levels of satisfaction towards interprofessional collaboration was reported among pediatric dentists, pediatricians, SLPs, RDN and administrative staff. CONCLUSION: Team-based pediatric dental clinic can be feasible and financially beneficial. Thus, a pediatric wellness care center that integrates general and dental care services through an interprofessional collaboration can play a vital role in significantly improving children’s oral and systemic health.
2022-07-29T00:00:00Z

This study examined if dental students could increase their level of reflective skills over time through composing reflective blogs during their introduction to patient care in their course, Clinical Practice of Dentistry I, and to document and analyze student perceptions of the use of reflective blogs, particularly pertaining to the clinical and metacognitive skills. The participants of this study included 69 third-year dental students. Reflective blogs were analyzed using a reflective rubric adapted from Wetmore, Boyd, Bowen & Patillio, 2010. Student perceptions regarding the use of reflective blogs were documented through a 14-question Likert-opinion survey and focus group interviews. Findings indicated reflective thought level increased significantly in all six reflective thought categories across the three assessed blogs. Overall, student perceptions of the use of reflective blogs were positive as based on a five-point Likert scale survey. They reported particularly high percentages for "I feel comfortable about reflecting on my clinical experiences" at ~ 90% Agree, "Reflective journals allow me to focus and think things over" at ~ 83% Agree, followed by "Reflective journals develop my ability to monitor and reflect on my own thinking processes"~ 74%. Both the qualitative and quantitative results of this study provide favorable evidence that reflective journaling is effective and in large measure is appreciated by students in their clinical phase of dental medical education.

Bibliography: leaves 203-219.
219 leaves : ill. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Concerned with the contribution of commonsense understandings of disease to social differentials in health outcomes. Argues that understandings in part reflect the social circumstances of an individual and mediate preventive activities and use of services, thereby influencing health outcomes. These are examined using the specific health outcomes of tooth loss and tooth decay.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2000