An important decline in DMFT was observed between 1980 and 2003, perhaps as a result of increased access to fluoridated water and toothpaste and of changes in the goals of public oral health programs. Despite the improvement, caries is unevenly distributed in the pediatric population; a small proportion of individuals carries most of the disease burden. In addition, the proportion of teeth with caries that went untreated did not change between 1980 and 2003. Reducing socioeconomic disparities and adopting public health measures that target and reach the most vulnerable groups remain a challenge for policy makers in Brazil.

The purpose of this study was to evaluate the addition of oral health teams to the Family HealthIntrodução O Programa Saúde da Família (PSF) tem se tornado, nos últimos anos, o principal programa alavancador da reorganização dos serviços de saúde na atenção básica. Tem como estratégia a reformulação do processo de trabalho inserido no contexto do Sistema Único de Saúde (SUS) e centrado na vigilância à saúde por meio de ações de promoção, prevenção e recuperação; baseia-se na nova concepção sobre o processo saúde-doença, com atenção voltada para a família e com ações organizadas em um território definido. Tornou-se o carro-chefe do modelo assistencial do SUS e foi concebido pelo Ministé-rio da Saúde como uma alternativa de promover a reformulação das ações em saúde, considerando que o modelo tradicional de assistência impôs um descompasso entre os princípios do SUS e a realidade concreta de implantação do sistema de saúde 1,2,3 .Entendendo a saúde bucal como integrante desse processo, a sua incorporação ao PSF tem sido vista como possibilidade de romper com os modelos assistenciais em saúde bucal excludentes baseados no curativismo, tecnicismo e biologicismo. Isso porque o PSF, de certa forma, tenta romper com a lógica programática desses modelos, visto que não só articula as propostas da vigilância à saúde baseando-se na integralidade, mas também possui como um de seus princípios a busca ativa de famílias, ARTIGO ARTICLE

The SBBrasil 2010 Project (SBB10) (5, 12, 15-19, 35-44, and 65-74 years).

Knowledge on the occurrence of multimorbidity is important from the viewpoint of public policies, as this condition increases the consumption of medicines as well as the utilization and expenses of health services, affecting life quality of the population. The objective of this study was to estimate prevalence of self-reported multimorbidity in Brazilian adults (≥18 years old) according to socioeconomic and demographic characteristics. A descriptive study is presented herein, based on data from the National Health Survey, which was a household-based survey carried out in Brazil in 2013. Data on 60,202 adult participants over the age of 18 were included. Prevalences and its respective confidence intervals (95%) were estimated according to sex, age, education level, marital status, self-reported skin color, area of residence, occupation and federative units (states). Poisson regression models univariate and multivariate were used to evaluate the association between socioeconomic and demographic variables with multimorbidity. To observe the combinations of chronic conditions the most common groups in pairs, trios, quartets and quintets of chronic diseases were observed. The prevalence of multimorbidity was 23.6% and was higher among women, in individuals over 60 years of age, people with low educational levels, people living with partner, in urban areas and among unemployed persons. The states of the South and Southeast regions presented higher prevalence. The most common groups of chronic diseases were metabolic and musculoskeletal diseases. The results demonstrated high prevalence of multimorbidity in Brazil. The study also revealed that a considerable share of the economically active population presented two or more chronic diseases. Data of this research indicated that socioeconomic and demographic aspects must be considered during the planning of health services and development of prevention and treatment strategies for chronic diseases, and consequently, multimorbidity.

The aim of this study was to associate minor psychiatric disorders (general health) and quality of life with temporomandibular disorders (TMD) in patients diagnosed with different TMD classifications and subclassifications with varying levels of severity. Among 150 patients reporting TMD symptoms, 43 were included in the present study. Fonseca's anamnestic index was used for initial screening while axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD) was used for TMD diagnosis (muscle-related, joint-related or muscle and joint-related). Minor psychiatric disorders were evaluated through the General Health Questionnaire (GHQ) and quality of life was assessed using the World Health Organization Quality Of Life-Brief Version (WHOQOL-BREF). An association was found between minor psychiatric disorders and TMD severity, except for stress. A stronger association was found with mild TMD. Considering TMD classifications and severity together, only the item "death wish" from the GHQ was related to severe muscle-related TMD (p = 0.049). For quality of life, an association was found between disc displacement with reduction and social domain (p = 0.01). Physical domains were associated with TMD classifications and severity and the association was stronger for muscle and joint-related TMD (p = 0.037) and mild TMD (p = 0.042). It was concluded that patients with TMD require multiple focuses of attention since psychological indicators of general health and quality of life are likely associated with dysfunction.

BackgroundThe chronic cumulative nature of caries makes treatment needs a severe problem in adults. Despite the fact that oral diseases occur in social contexts, there are few studies using multilevel analyses focusing on treatment needs. Thus, considering the importance of context in explaining oral health related inequalities, this study aims to evaluate the social determinants of dental treatment needs in 35–44 year old Brazilian adults, assessing whether inequalities in needs are expressed at individual and contextual levels.MethodsThe dependent variables were based on the prevalence of normative dental treatment needs in adults: (a) restorative treatment; (b) tooth extraction and (c) prosthetic treatment. The independent variables at first level were household income, formal education level, sex and race. At second level, income, sanitation, infrastructure and house conditions. The city-level variables were the Human Development Index (HDI) and indicators related to health services. Exploratory analysis was performed evaluating the effect of each level through calculating Prevalence Ratios (PR). In addition, a three-level multilevel modelling was constructed for all outcomes to verify the effect of individual characteristics and also the influence of context.ResultsIn relation to the need for restorative treatment, the main factors implicated were related to individual socioeconomic position, however the city-level contextual effect should also be considered. Regarding need for tooth extraction, the contextual effect does not seem to be important and, in relation to the needs for prosthetic treatment, the final model showed effect of individual-level and city-level. Variables related to health services did not show significant effects.ConclusionsDental treatment needs related to primary care (restoration and tooth extraction) and secondary care (prosthesis) were strongly associated with individual socioeconomic position, mainly income and education, in Brazilian adults. In addition to this individual effect, a city-level contextual effect, represented by HDI, was also observed for need for restorations and prosthesis, but not for tooth extractions. These findings have important implications for the health policy especially for financing and planning, since the distribution of oral health resources must consider the inequalities in availability and affordability of dental care for all.

O objetivo deste estudo dentro dos Estudos de Linha de Base do Proesf foi avaliar o impacto do Programa Saúde da Família sobre indicadores relacionados à saúde da criança em municípios com mais de 100 mil habitantes. Foram pesquisados quatro municípios na região Nordeste, e em cada um deles foram sorteados 20 setores censitários em áreas cobertas pelo PSF e emparelhados a outros 20 setores em áreas não cobertas pelo PSF, a partir de critérios socioeconômicos. Os resultados mostraram que, na maior parte dos indicadores, não se observam diferenças significativas entre os resultados de áreas cobertas e não cobertas pelo PSF, destacando-se apenas a redução na taxa de internação por diarréia. Em relação a esta, a redução significativa se deu às expensas do Programa de Agentes Comunitários de Saúde, não trazendo o PSF efeito adicional sobre a redução do indicador. Pôde-se observar, também, que o modo como o programa é implementado em cada município influencia diretamente nos resultados, de modo que não há subsídios claros para decretar o PSF "per si" pouco resolutivo e sem diferencial em seus padrões de assistência à saúde. Torna-se, portanto, necessário levar em conta a análise do contexto da implantação e condução do PSF, além de suas características mais gerais relativas ao campo socioeconômico e de políticas públicas.

A Lei Orgânica da Saúde 1 preconiza como um de seus princípios o acesso universal e gratuito aos serviços e ações de saúde. A utilização dos serviços odontológicos é um item que permite uma aproximação a esse elemento, contribuindo para identificar como esse acesso pode ser obtido de forma a permitir a melhoria de saúde bucal da população brasileira.A saúde bucal, na maioria dos municípios brasileiros, segundo Gomes et al. 2 , constitui ainda um grande desafio aos princípios do Sistema Único de Saúde (SUS), principalmente no que se refere à universalização e à eqüidade do atendimento. Dados da Pesquisa Nacional por Amostra de Domicílios de 1998 (PNAD/1998) 3 demonstram que o atendimento odontológico se diferencia fortemente do atendimento médico, com uma proporção muito mais baixa de atendimentos financiados pelo SUS ou por planos de saúde, em comparação com os financiados diretamente. Tal situação remete à observada na Austrália 4 onde a cobertura universal de cuidados de saúde exclui o tratamento odontológico, fazendo com que de 80% a 90% dos procedimentos sejam custeados diretamente pelo consumidor ao sistema privado de assistência odontológica.Apesar da reconhecida importância da saúde bucal, uma parcela considerável da população brasileira não tem acesso aos serviços de saúde 5 , dificultado pela falta evidente de articulação da