To examine the caries situation in Brazilian schoolchildren between 1980 and 2003 and to determine the distribution of caries and access to treatment in this population group. We employed secondary data concerning the number of decayed, missing or filled teeth (DMFT). The studies whose data were used differed in terms of study type, study design, sampling methods, and diagnostic criteria, but yielded national estimates that are considered valid for the DMFT index. Therefore, a trend analysis based on these studies was thought to be feasible. Analysis of DMFT values revealed a high frequency of dental caries in 1980 and a moderate frequency in the 1990s. In 2003, the DMFT index was still within the moderate range. Between 1980 and 2003, a 61.7% decrease in DMFT frequency was observed. The percentage of children with no DMFT increased from 3.7% in 1986 to 31.1% in 2003. On the other hand, in the segment of the study population least affected, the percentage of children who received care increased from 26.3 in 1986 to 34.7 in 2003, yet in the group with DMFT this percentage fell from 50.2 in 1986 to 39.3 in 2003. In the segment with DMFT >/=6, the percentage of those who received care remained stable (28%). During the study period, 60% of the dental caries were found in 20% of the study population. 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.

OBJETIVO: Estimar a prevalência do uso de serviços odontológicos por pré-escolares e fatores associados. MÉTODOS: Estudo transversal com 1.129 crianças de cinco anos de idade da Coorte de Nascimentos de Pelotas 2004, RS, de setembro de 2009 a janeiro de 2010. Registrou-se o uso de serviço odontológico pelo menos uma vez na vida e o motivo para a primeira consulta odontológica da criança. As categorias do desfecho foram: ter feito a primeira consulta por rotina, para resolver um problema ou nunca ter ido ao dentista. Os exames bucais e as entrevistas foram realizados nos domicílios. Aspectos socioeconômicos e variáveis independentes ligadas à mãe e à criança foram analisados por meio de regressão logística multinomial. RESULTADOS: A prevalência de uso por qualquer motivo foi 37,0%. Os principais preditores para consulta de rotina foram nível econômico mais elevado, mãe com maior escolaridade e ter recebido orientação sobre prevenção. Principais preditores para consulta por problema foram ter sentido dor nos últimos seis meses, mãe com maior escolaridade e ter recebido orientação sobre prevenção. Cerca de 45,0% das mães receberam orientação de como prevenir cárie, principalmente fornecida por dentistas. Filhos de mães com história de maior aderência a programas de saúde tiveram maior probabilidade de ter feito uma consulta odontológica de rotina. CONCLUSÕES: A taxa de utilização dos serviços odontológicos por pré-escolares foi inferior às de consultas médicas (puericultura). Além da renda e da escolaridade, comportamentos maternos têm papel importante no uso por rotina. Relato de dor nos últimos seis meses e número elevado de dentes afetados por cárie, independentemente dos demais fatores, estiveram associados ao uso para resolver problema. É necessária a integração de ações de saúde bucal nos programas materno-infantis.

ResumoA colaboração interprofissional vem sendo apontada como um recurso para o enfrentamento dos problemas do modelo de atenção e da força de trabalho. O objetivo do estudo foi captar a percepção de profissionais que atuam na atenção primária à saúde sobre o trabalho compartilhado e a colaboração interprofissional. Uma pesquisa qualitativa foi conduzida no município de São Paulo, mediante a realização de entrevistas em profundidade com profissionais de distintas categorias que atuam na Estratégia Saúde da Família e no Núcleo de Apoio à Saúde da Família. Os resultados permitiram evidenciar as categorias: ‘interação profissional’ e ‘metas de produção’. As formas de interação, o papel do apoio especializado matricial e o modo como as metas de produção são percebidas apontaram para tensões entre a lógica profissional tradicional e a da colaboração; e entre um modelo centrado em procedimentos especializados e outro mais colaborativo, focado nas necessidades de saúde das famílias e da comunidade. O compartilhamento de responsabilidades e práticas, a alteração da lógica dos encaminhamentos e a insuficiência de dispositivos organizacionais permanecem como importantes desafios para a inserção da colaboração interprofissional no desenvolvimento de novas práticas de produção do cuidado.

Dental caries remains highly prevalent in Latin American and Caribbean countries (LACC). However, this disease can be controlled through interventions that implement evidence-based strategies in an affordable manner and that target all population groups instead of the most affluent only. Therefore, the aim of this report was to summarize the main scientifically documented community interventions and strategies based on restriction of sugars consumption, use of fluoride, and the use of occlusal sealants for caries control in LACC. A critical literature review was carried out in a systematic manner that included defined search strategies, independent review of the identified publications, and compilation of results in this report. Three systematic searches were conducted using the PubMed, LILACS, and SciELO databases to identify studies related to community interventions and strategies for caries control in LACC. Of the 37 publications identified, twenty-six focused on fluoride use, eight on occlusal sealant use, and three on the restriction of sugar consumption. Documented community interventions for sugars restriction were scarce in the region and were based on food supplementation, sugar replacement, and education. Thus, local and/or national policies should prioritize investment in upstream, coherent, and integrated population-wide policies such as taxes on sugary drinks and stronger regulation of advertising and promotion of sugary foods and drinks mainly targeting children. The main fluoride-based strategies used drinking water, refined domestic salt, cow milk, toothpaste and, to a lesser extent, mouth-rinses, acidulated phosphate fluoride (APF) gels, and varnishes to deliver fluoride to the population. Evidence of fluoride use was seen in Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela. Studies reporting the use of occlusal sealants were mainly located in Brazil, Chile, Colombia, Costa Rica, Peru, Mexico, and Venezuela. Community interventions restricting sugar consumption should be implemented at the individual level and through public policies. The use of fluoride must be monitored at the local, regional, and national levels so as to achieve maximum anti-caries effect while also minimizing the risk of dental fluorosis. Moreover, fluoridated water and salt programs, used as a mutually exclusive community level strategy for caries control, should expand their benefits to reach non-covered areas of the LACC while also simultaneously providing adequate surveillance of the fluoride concentration delivered to the population. Regulating the concentration of soluble fluoride (for anti-caries effect) in dentifrice formulations is also necessary in order to provide the population with an effective strategy for disease control. Targeting culturally appropriate, economically sustainable caries control interventions to rural populations and native ethnic groups such as indigenous people, quilombolas (African-origin), and riverside Amazonian people remains a crucial challenge.

The widespread expansion of the sugar market drove dental caries prevalence to high levels in several regions of the world. On the other hand, the dissemination of fluoride use is one of the reasons for caries decline at the end of the 20th century. However, caries remains one of the most prevalent non-communicable chronic diseases in human beings, and an important cause of pain and dental loss, which lead to school and work absenteeism affecting individuals' daily activities and emotional stability. The decline in caries has important implications for research, human resources and oral healthcare. The aim of this study was to summarize the changes in dental caries occurrence in the population, and bring to light the latest research on the role of non-biological determinants in caries distribution.