Indicators for monitoring oral health services in primary care: content validation and measurability Raquel Conceição Ferreira, Loliza Luiz Figueiredo Houri Chalub, João Henrique Lara do Amaral, Rafaela da Silveira Pinto, Jacqueline Silva Santos, Fernanda Lamounier Campos, Elisa Lopes Pinheiro, Maria Inês Barreiros Senna Ciencia E Saude Coletiva, 2025 Resumo Estudo metodológico de criação, validação de conteúdo e avaliação da mensurabilidade de indicadores para o monitoramento dos serviços de saúde bucal na atenção primária à saúde (APS). Indicadores foram elaborados a partir de variáveis registradas nas fichas de atendimento odontológico individual e atividades coletivas do e-SUS APS. Um comitê de 46 painelistas avaliou os indicadores, obtendo-se o percentual de concordância entre eles quanto à relevância da medida, transparência do método de cálculo e se eles mediam a dimensão teórica. A mensurabilidade foi avaliada usando dados do Sistema de Informação em Saúde para a Atenção Básica (SISAB), para cada município brasileiro, em 2022. Foi obtido o percentual de municípios que apresentavam dados não nulos para o numerador e/ou denominador. Foram validados 68 indicadores (concordância > 75%) e demonstrada a mensurabilidade de 53, nas subdimensões “acesso aos serviços de saúde bucal” (9), “vigilância em saúde bucal” (5), “diagnóstico, tratamento e reabilitação em saúde bucal” (16), “promoção e prevenção” (14), “atuação intersetorial/participação popular” (4) e “processo de trabalho” (5). O percentual de municípios com indicadores calculados variou de 0,97 a 95,40%.
Association between shortened dental configurations and health outcomes: a scoping review Fernanda Lamounier Campos, Lorrany Gabriela Rodrigues, Julya Ribeiro Campos, Gabriela Aparecida Caldeira Rhodes, Gabrielli Flores Morais, Loliza Luiz Figueiredo Houri Chalub, Raquel Conceição Ferreira BMC Oral Health, 2024 This study mapped definitions of shortened dental configurations and health outcomes employed in association studies. A scoping review was conducted using the PubMed/Medline, Scopus, Web of Science, SciELO and Cochrane databases. Two trained researchers selected studies and extracted data. Studies that investigated the association between shortened dental configurations (exposure) and person-centered outcomes (general and oral health) related to health behavior (dietary patterns). Clinical outcomes were classified according to the International Classification of Functioning, Disability and Health and the International Classification of Diseases of the World Health Organization (WHO). Shortened dental configurations were defined as at least 20/21 teeth or the position of the teeth, including esthetics, dental occlusion and periodontal status (Eichner Index, Shortened Dental Arches, Functional Dentition Classification System, Posterior Occluding Pairs, Functional Tooth Units). The initial search resulted in 12,525 records in English, Portuguese and Spanish, 432 of which addressed the association of interest. General health (n = 203) and oral health (n = 201) were addressed in a similar number of studies. Most outcomes were related to general health (n = 184), the most frequent of which were endocrine, nutritional or metabolic diseases (n = 57) and mental functions (n = 26). Person-centered measures were addressed in 153 studies, most of which were about oral health and oral health-related quality of life (n = 62). Oral health outcomes were predominantly related to intake functions (n = 44) and diseases or disorders of the orofacial complex (n = 24). Dietary patterns (n = 43) and mortality (n = 38) were also studied. The cross-sectional design (n = 257) and non-probabilistic sampling (n = 218) were more frequent. The shortened dental configurations defined by the WHO were the most frequent in the studies (n = 206). The effects of shortened dental configurations have been investigated mainly in relation to endocrine, nutritional or metabolic diseases and measures of oral health-related quality of life. The findings point to a diversity of health outcomes assessed and substantial methodological variability.
Validation of pairs of antagonist teeth for the evaluation of shortened dental arch in epidemiological studies Fernanda Lamounier CAMPOS, Gabriela Aparecida Caldeira RHODES, Walison Arthuso VASCONCELLOS, Rafael Aiello BOMFIM, Aline Araujo SAMPAIO, Loliza Luiz Figueiredo Houri CHALUB, Raquel Conceição FERREIRA Brazilian Oral Research, 2023 The aim of this study was to evaluate the accuracy of pairs of antagonist teeth (epidemiological criterion) for defining pairs of teeth in occlusal contact (clinical criterion) and to estimate the agreement between the prevalence of "shortened dental arch" (SDA) and "functional dentition" (FD) when occlusal units (OUs) or posterior occluding pairs (POPs) are defined by the epidemiological or clinical criterion. Data were collected in an epidemiological oral health survey conducted in a municipality in Minas Gerais, Brazil. OUs and POPs were defined by the epidemiological criterion (dental crown status) or clinical criterion "gold standard" (carbon paper record of occlusal contacts during habitual maximum intercuspation). SDA corresponded to the presence of an intact anterior region and three to five OUs. FD was based on the concomitant presence of ≥ 1 tooth in each arch, 10 teeth in each arch, 12 anterior teeth, ≥ 3 premolar POPs, and ≥ 1 molar POP bilaterally. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the epidemiological criterion were calculated. The study included 197 adults. Sensitivity, specificity, PPV, and NPV were 88.5, 87.9, 92.5, and 81.9%, respectively, and accuracy was 88.3%. The epidemiological criterion proved to be valid and could be used in epidemiological studies to calculate the prevalence of reduced dental configurations that consider POPs. The assessment of oral functionality is an aspect that should be included in the diagnosis of the clinical condition of patients, contributing to a more effective individual and collective oral health care plan.
Brazilian Adults Believe that Complete Dentures would be the Solution to the Oral Impacts Caused by Reduced Dentition Fernanda Lamounier Campos, Ichiro Kawachi, Gabriela Aparecida Caldeira Rhodes, Aline Araujo Sampaio, Loliza Luiz Figueiredo Houri Chalub, Raquel Conceição Ferreira Pesquisa Brasileira Em Odontopediatria E Clinica Integrada, 2022 Objective: To evaluate the direct and oral impact-mediated association between reduced dentitions and the self-perceived need for complete dentures (CD) in dentate adults. Material and Methods: Data from the Brazilian Oral Health Survey (2010) were analyzed. The outcome was self-perceived need for CD. Functional dentition (FDClassV) was defined by the presence of the following criteria: level I -1 tooth in each arch, level II -10 teeth in each arch, level III -12 anterior teeth, level IV - 3 posterior occluding pairs (POPs) of premolars and level V -1 bilateral POPs of molars. Oral impacts were assessed with Oral Impacts on Daily Performances scale. Results: FDClassV was associated with a less self-perceived need for CD both directly and mediated by oral impacts. Dentitions without level V were associated with the outcome mediated by oral impacts. Between individuals with 10 teeth in each arch, self-perceived need for CD was similar for those who had or not anterior teeth and POPs. Individuals with <10 teeth in each arch and level III did not have a higher frequency of self-perceived need for CD compared to those with level II. Conclusion: Oral impacts mediated the association between reduced dentitions and self-perceived need for CD. Individuals with tooth loss may report need for CD, even when they have dental configurations compatible with functionality.
Do COVID-19 Control Guidelines for Long-Term Care Facilities Include Oral Healthcare Orientations? Lorrany G. Rodrigues, Fernanda L. Campos, Letícia S. Alonso, Raquel S. Silva, Bruna C. Oliveira, Gabriela A. C. Rhodes, Milena R. S. Dias, Doane M. Silva, Aline A. Sampaio, Raquel C. Ferreira Journal of the American Geriatrics Society, 2020 The guidelines for managing COVID-19 regarding LTCFs have not addressed specific oral health hygiene. A guideline with this orientation could contribute to the staff and older adults health. There are more questions than answers. However, oral health care must be discussed among interdisciplinary health professionals so that there are advances in the guidelines qualifying the care practices for older adults.
Education and income-based inequality in tooth loss among Brazilian adults: Does the place you live make a difference? Raquel Conceição Ferreira, Maria Inês Barreiros Senna, Lorrany Gabriela Rodrigues, Fernanda Lamounier Campos, Andrea Eleuterio Barros Lima Martins, Ichiro Kawachi BMC Oral Health, 2020 Background Socioeconomic inequalities in tooth loss might be minimized or potentialized by the characteristics of the context where people live. We examined whether there is contextual variation in socioeconomic inequalities in tooth loss across Brazilian municipalities. Methods Data from the 2010 National Oral Health Survey of 9633 adults living in 157 Brazilian municipalities were used. The individual socioeconomic indicators were education and household income. At the municipal level, we used the Municipal Human Development Index (HDI) as our contextual indicator of socioeconomic status (low:< 0.699 versus high: > 0.70). The Relative (RII) and Slope (SII) Indexes of Inequality, Relative (RCI), and Absolute (ACI) Concentration Indexes were calculated to compare the magnitude of education and income-based inequalities among municipalities with low versus high HDI. Multilevel Poisson regression models with random intercepts and slopes were developed. Results At the individual level, adults with lower education & income reported more tooth loss. The mean number of missing teeth was 9.52 (95% CI: 7.93–11.13) and 6.95 (95% CI: 6.43–7.49) in municipalities with low and high HDI, respectively. Municipalities with high HDI showed higher relative and absolute education-based inequality. For income-based inequalities, higher SII and RCI was observed in municipalities with lower HDI. A significant cross-level interaction indicated that high-education adults reported fewer missing teeth when they lived in municipalities with high HDI compared to adults with the same education level living in low HDI municipalities. For individuals with the lowest education level, there was no difference in the number of teeth between those from municipalities with high and low HDI. Conclusions There was a social gradient in tooth loss by education and income. Living in disadvantaged municipalities cannot overcome the risk associated with low schooling. The protective effect of higher education can be reduced when people live in disadvantaged areas.
Guideline for oral care of dependent elders: Mapping review and cross-cultural adaptation to Portuguese-Brazil Rafaella Mendes de JESUS, Fernanda Lamounier CAMPOS, Lorrany Gabriela RODRIGUES, Matheus de França PERAZZO, Anna Rachel dos Santos SOARES, Marco Túlio de Freitas RIBEIRO, Aline Araújo SAMPAIO, Raquel Conceição FERREIRA Brazilian Oral Research, 2020 This study aimed to map evidence-based guidelines for oral care of the dependent elders and perform the cross-cultural adaptation to Brazilian Portuguese. Initially, a systematized review was conducted in Medline, Scielo, Scopus, Web of Science, and Google Scholar databases without restrictions in search period or type of study. Articles in English, Spanish, and Brazilian Portuguese describing evidence-based guidelines for oral care, including oral hygiene recommendations, of institutionalized dependent elders were included as long as they presented an evaluation of evident quality. The guideline that met inclusion criteria was submitted to cross-cultural adaptation after obtaining permission from the original authors. Two hundred and nineteen references were found. Three selected articles described evidence-based guidelines for oral care, but the Oral Health Care Guideline for Older People in Long-term Care Institutions (OGOLI), originally developed and implemented in the Netherlands, was selected. It was based on evidence level A2 and consensus of experts and met the quality requirements of the Appraisal of Guidelines for Research & Evaluation (AGREE). This guideline presents oral care recommendations for elders with different levels of dependence in activities of daily living to be performed by caregivers and nursing staff. The adaptation of the OGOLI was mainly on the attributions of care providers, given the differences in professional regulations between Brazil and the Netherlands. The cross-cultural equivalence between OGOLI and its Brazilian Portuguese version was verified.
Is reduced dentition with and without dental prosthesis associate with oral health-related quality of life? A cross-sectional study Raquel Conceição Ferreira, Ichiro Kawachi, João Gabriel Silva Souza, Fernanda Lamounier Campos, Loliza Luiz Figueiredo Houri Chalub, José Leopoldo Ferreira Antunes Health and Quality of Life Outcomes, 2019 BACKGROUND: Oral health-related quality of life (OHRQoL) has important implications for the clinical practice of dentistry and dental research and should contribute to professional judgment about restorative treatments and prosthetic replacement in patients who had reduced dentitions. The aim was to compare the OHRQoL among adults (35-44 years) categorized according to different definitions of reduced dentition and considering the use (or non-use) of dental prosthesis. METHODS: This study used data from a probabilistic sample of adults in Sao Paulo, Brazil, 2015. OHRQoL was based on none items of Oral Impacts on Daily Performance (OIDP) index, as prevalence (at least one impact) and extent (the number of items with non-zero score). We used different criteria to assess dentition status: (1) Shortened Dental Arch (SDA): having 3-5 natural occlusal units (OUs) in posterior teeth and intact anterior region; (2) hierarchical functional classification system: a five-level stepwise classification of dentition; and (3) presence of ≥21 teeth. The use or nonuse of dental prosthesis was recorded. Negative binomial regression models involved the adjustment for social determinants of health. RESULTS: Nearly half (53.1%) of the 5753 participating adults had at least one oral health issue impacting OHRQoL. OIDP prevalence in adults with SDA did not differ from those with more OUs (PR = 1.02; 95%CI 0.91-1.13). Individuals with non-functional dentition had worse OHRQoL regardless of their use of a dental prosthesis. Adults with fewer than 21 remaining teeth, ranked significantly higher in OIDP extent, regardless of dental prosthesis use (PR = 1.38; 95%CI 1.16-1.63 with prosthesis; PR = 1.62; 95%CI 1.19-2.20 without dental prosthesis). CONCLUSIONS: Individuals with more missing teeth reported worse OHRQoL regardless of using a dental prosthesis. Preserving a functional dentition, even with missing teeth, is compatible with OHRQoL.
Organization and resolubility of public dental services to the oral health care of preschool children: study of two Brazilian cities Anna Rachel dos Santos Soares, Fernanda Lamounier Campos, Paula Cristina Pelli Paiva, Mara Vasconcelos, Maria Inês Barreiros Senna, Raquel Conceição Ferreira Arquivos Em Odontologia, 2019 Introdução: A organização da Atenção Primária à Saúde (APS) na Atenção à Saúde Bucal influencia os resultados de atendimento de crianças. Conhecer as características do serviço para minimizar e controlar o aparecimento das doenças bucais é de extrema importância. Objetivo: Descrever a organização e a resolutividade da rede pública de saúde para a atenção em saúde bucal de crianças de zero a seis anos em dois municípios brasileiros. Materiais e Métodos: Estudo de caso exploratório foi realizado com dados secundários dos prontuários de crianças atendidas em 2014 pelos serviços de saúde bucal [convencional ou Equipes de Saúde Bucal (ESB)] nos municípios de Belo Horizonte e Diamantina, Minas Gerais, Brasil. A resolutividade foi avaliada pela relação entre os percentuais de Tratamento Odontológico Concluído (TC) e de Primeira Consulta (PC). Nos dois municípios, a Estratégia Saúde da Família (ESF) é o modelo de organização dos serviços da APS. Em Belo Horizonte, amostra representativa das crianças examinadas no Levantamento de Necessidades pelas ESB foi selecionada de 18 das 147 Unidades Básicas de Saúde (UBS). Em Diamantina, a organização do atendimento odontológico é o convencional e dá-se por livre demanda, sendo realizado em 4 das 7 UBS. Análise descritiva dos dados foi realizada para obtenção de frequências absolutas e relativas. Resultados: Foram analisados 1.344 prontuários em Belo Horizonte, 595 deles de crianças (44,3%) que tiveram PC. Destas, 295 (21,95%) tiveram TC, com resolutividade de 49,54%. No município de Diamantina, todos os 43 prontuários odontológicos de crianças encontrados nas UBS com atendimento odontológico foram avaliados. Destas, 29 crianças (67,44%) tiveram a PC e 11 (25,58%) TC, representando resolutividade de 37,94%. Conclusão: Há diferenças na organização e no modelo de atenção em saúde bucal para crianças nos municípios estudados, que apresentaram diferenças quanto ao acesso e resolutividade dos serviços para esta faixa etária.
 Descritores: Assistência odontológica; Avaliação em saúde; Resolutividade; Epidemiologia; Estratégia Saúde da Família.
Dependence on others for oral hygiene and its association with hand deformities and functional impairment in elders with a history of leprosy Raquel Conceição Ferreira, Talita Xavier Gonçalves, Anna Rachel dos Santos Soares, Luísa Rodrigues de Abreu Carvalho, Fernanda Lamounier Campos, Marco Túlio de Freitas Ribeiro, Andrea Maria Eleutério de Barros Lima Martins, Efigênia Ferreira e Ferreira Gerodontology, 2018 ObjectiveTo analyse the frequency of dependence on others for oral hygiene and its association with hand deformities, frailty and dependence on others for basic activities of daily living (BADL) among elders with a history of leprosy.BackgroundDependence on others for oral hygiene has not been considered in multifunctional geriatric assessments.Material and methodsEdentulous elders with a history of leprosy who used complete dentures and resided in a former leprosy colony were classified as independent or partially/completely dependent on others for brushing their dentures or rinsing and for BADL, and as frail or robust. The presence of hand deformities was assessed by an occupational therapist.Results28.4% and 14.9% were completely/partially dependent on others for brushing and rinsing, respectively. The dependence for BADL was observed in 21.6% and hand deformities in 17.6%. A higher odds of dependence for brushing/rinsing was found among elders who were dependent on others for BADL. Brushing dependence (61.5%) was more frequent among participants with hand deformities than those without this condition (21.3%) (OR: 6.8; 95% IC: 1.2‐37.9;P = .028). There was no association between frailty and brushing (P = .068) or rinsing (P = .202) dependence.ConclusionApproximately one‐third of elders have a dependence on others for brushing; a smaller proportion is dependent on others for rinsing. Older people who are dependent on others for BADL and who present hand deformities are more likely to be dependent on others for denture brushing and rinsing. Elders may perform oral self‐care even when they present frailty.