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A ouvidoria estabelece um canal prático e de fácil acesso aos usuários do serviço público, ao mesmo tempo que induz, nas instituições, práticas de análises e avaliações dos proce-dimentos de trabalho a partir das percepções dos usuários. Então, objetivou-se identificar o fluxo das demandas recebidas pela Ouvidoria SUS Recife, o perfil dos demandantes e das demandas, e como esse instrumento é utilizado para gestão dos serviços odontológicos do município. Realizou--se um estudo descritivo, quali-quantitativo, submetendo-se dados da Ouvidoria SUS Recife de 2008 a 2017 à estatística descritiva e dados obtidos em grupo focal com cinco coordenadores de saúde bucal do município à análise de conteúdo na modalidade temática de Bardin.Identificou-se um desconhecimento dos entrevistados sobre o fluxo instalado na Ouvidoria SUS Recife, eviden-ciando fragilidade de comunicação e articulação entre a ouvidoria e os gestores de saúde bucal do município. Das 820 demandas analisadas, constatou-se que mulheres de 40-49 anos, com ensino fundamental completo, compõem o principal perfil dos demandantes da Ouvidoria SUS Recife. Das demandas, 75,2% foram reclamações, sendo recursos humanos o assunto mais citado (36,1%). A maior potencialidade da ouvidoriaidentificada pelos gestores foi representada pela visibilidade que ela promove das demandas da sociedade, subsidiando a tomada de decisão dos gestorespara aprimorar os serviços. Entretanto, a ouvidoria ainda ésubutilizada pelos cidadãos, o que compro-mete o uso potencial da ouvidoria como uma ferramenta de gestão. (AU)

The ombudsman establishes a practical channel for public service users, while induces practices of analysis and evaluation of work procedures based on users' perceptions. The aim was to identify the flow of the demands received by SUS Recife Ombudsman, the profile of the claimants, the demands, and how this instrument is used to manage the dental services of the municipality. A descriptive, qualitative-quantitative study was carried out, submitting data from the SUS Recife Ombudsman from 2008 to 2017 to descriptive statistics and data obtained from a focal group with five oral health coordinators from the municipality to content analysisof the thematic modality of Bardin. It was identified a lack of knowledge of respondents about the flow installed in the SUS Recife Ombudsman, showing weakness of communication and articulation between the ombudsman and the oral health managers of the municipality. Of the 820 demands analyzed, women aged 40-49, with complete elementary education, make up the main profile of the SUS Recife Ombudsman. Of the demands, 75.2% were complaints, with human resources being the most cited subject (36.1%). The greater potential of the ombudsman identified by managers was represented by the visibility it promotes of society's demands, supporting managers' decision-making to improve services. However, the ombudsman is still underutilized by citizens, which compromises the potential use of the ombudsman as a management tool. (AU)

El Defensoría establece un canal práctico y de fácil acceso para los usuarios del servicio público y induce, en las instituciones, prácticas de análisis y evaluación de los procedimientos de trabajo desde las percepciones de los usuarios. El objetivo del estudio fue identificar el flujo de demandas recibidas por el Defensoría del SUS Recife, el perfil de los demandantes y las demandas, y cómo se utiliza este instrumento para la gestión de los servicios dentales del municipio. Se realizó un estudio descriptivo, cualitativo y cuantitativo, presentando datos del Defensoría del SUS Recife de 2008 a 2017 a estadísticas descriptivas y datos de un grupo focal con cinco coordinadores de salud oral para el análisis de contenidomodalidad temática de Bardin. Se identificó una falta de conocimiento de los encuestados sobre el flujo instalado en el Defensoría, muestrando debilidad en la comunicación y la articulación entre el defensoría y los gerentes. De las 820 demandas analizadas, las mujeres de 40 a 49 años, con educación primaria completa, conforman el perfil principal de los acusados del Defensoría del SUS Recife. De las demandas, 75.2% fueron quejas, siendo los recursos humanos el tema más citado (36.1%). El mayor potencial del defensoría identificado por los gerentes estuvo representado por la visibilidad que promueve de las demandas de la sociedad, apoyando la toma de decisiones de los gerentes para mejorar los servicios. Sin embargo, el defensoría todavía está infrautilizado por los ciudadanos, lo que compromete el uso potencial del defensoría como herramienta de gestión. (AU)

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Trata-se de um estudo transversal conduzido em uma população de 308 crianças, entre 6 e 8 anos de idade, frequentadoras de uma escola municipal de Recife/PE. Objetivou-se identificar a influência de fatores sociodemográficos, práticas alimentares e de higiene oral e acesso aos serviços de saúde bucal na gravidade da cárie dentária em crianças. Considerou-se como gravidade de cárie ceo-d maior ou igual à média encontrada na amostra estudada (ceo-d ≥ 3). A análise de regressão logística mostrou que crianças cujas mães tinham idade entre 20 e 30 anos, não receberam orientação sobre higiene bucal no pré-natal e apresentaram mais de 10 dentes afetados por cárie tiveram uma chance de 2,0 a 2,5 vezes maior de apresentar o índice ceo-d ≥ 3. As crianças que não tiveram a higiene bucal realizada após a ingestão de leite industrializado/suco/chá no primeiro ano de vida e foi referido dor/sangramento/trauma como motivo do primeiro atendimento odontológico tiveram chance de 2,0 e 3,0 vezes maior de apresentar o desfecho de interesse, respectivamente. Assim, a gravidade de cárie na população estudada mostrou-se associada à idade e experiência de cárie materna, à ocorrência de orientação sobre saúde oral do bebê durante o pré-natal, aos hábitos de higiene bucal adotados no primeiro ano de vida e ao acesso da criança aos serviços odontológicos (AU).

This is a cross-sectional study conducted in a population of 308 children aged 6 to 8 years old, attending a public school in Recife/PE that had the objective to identify the influence of sociodemographic factors, diet and oral hygiene habits, and access to oral health services in the severity of dental caries in children. Caries severity was considered as those with dmft index greater than or equal to the mean found for the studied sample (dmft ≥3). The logistic regression analysis showed that children whose mothers were aged between 20 and 30 years old, had not received oral hygiene counseling during prenatal care and had more than 10 teeth affected by caries had a chance 2.0 to 2.5 times higher to have dmft ≥3. Children who had no oral hygiene performed after drinking formula milk/juice/tea during the first year of life and was referred pain/bleeding/trauma as a reason for the first dentistry attendance had a chance 2.0 and 3.0 times higher to have the outcome of interest, respectively. Thus, the severity of caries in the studied population was associated with maternal age and caries experience, the occurrence of counseling on infant's oral health during prenatal care, oral hygiene habits adopted in the first year of life, and access to children's dental services (AU).

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PURPOSE: To identify factors associated with dental caries experience in at least four primary teeth in five-year-old Brazilian children. METHODS: This was a case-control study, part of a prior investigation of the prevalence of dental caries in the primary dentition of five-year-old children conducted in 2006 in public health services in Recife, Brazil. Study patients had a decayed, missing, and filled teeth [dmft] score ≥ 4 and controls had a dmft score ≤ 3. The cutoff point was based on the dmft scores mean value of the study population. Categories of independent variables were sociodemographic, family structure, oral health behavior, and use of oral health services. Crude odds ratios and 95% CI were calculated. Variables associated with dmft greater than or equal to four at a significance level of P≤.20 in univariate analyses were included in multivariate logistic regression models using a backward stepwise variable selection method and permanence criterion in the final model of P≤.10. RESULTS: The study included 479 children (171 study patients and 308 controls). After controlling for confounding variables, factors associated with a dmft score ≥ 4 were children living in households with at least six people, residence in a poor area, caregiver's low educational level, consumption of sweets between meals, and the reason for and location of oral health care seeking. CONCLUSION: Most factors associated with high levels of dental caries in five-year-old children were related to the social conditions in which they lived.

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To report a rare case of a lateral frenum hypertrophy in an infant, this paper describes the case of a girl who came to a first dental appointment when she was 4 months old. A hypertrophic lateral frenum in the upper left canine region was detected. A great depression in the gingival rodet separated the anterior maxillary segment from the posterior one and also decreased the lip mobility in this region. A frenectomy was performed when the patient was 11 months old and the clinical follow-up was done up to the age of 30 months. There was normalization in the vestibular insertion of the lateral frenum, lip mobility, physiological development of the maxilla, and eruption of the upper incisors, canines, and first primary molars. Infants should go to a dental examination precociously in order to detect possible congenital and development alterations.

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O atendimento a crianças com traumatismos na dentição decídua requer uma abordagem diferente daquela utilizada na dentição permanente, isso porque existe uma relação muito próxima entre o ápice do dente decíduo afetado pelo trauma e o germe do dente permanente sucessor. As possíveis repercussões sobre o dente permanente devem ser consideradas ao se realizar o tratamento imediato, de modo a evitar danos adicionais. também precisam ser levadas em conta as prováveis seqüelas tardias do trauma, tanto para a própria dentição decídua como para a permanente. Diante da importância do assunto, este capítulo procurou abordar tal tema de maneira ampla, desde a anamnese até os exames gerais, intrabucal e radiográfico, com vistas a analisar integralmente o paciente. Além da classificação das lesões traumáticas nos tecidos dentários e de sustentação, enfatizam-se o diagnóstico, o tratamento indicado, o prognóstico e a proservação de cada situação clínica. Um tópico sobre lesão em tecido mole foi incluído, pois esta tem grande impacto para a criança e sua família e pode estar associada a outros tipos de traumatismos. Como a análise da situação vacinal da criança é sugerida, ante a existência de casos que exigem que a vacina antitetânica esteja na sua validade, acrescentou-se a recomendação do Ministério da Saúde quanto á imunização antitetânica. Há também um item sobre contenção, orientação aos pais e repercussões do trauma para os dentes decíduos e os permanentes sucessores. Ao final do capítulo, duas tabelas resumem o tratamento das lesões traumáticas em tecidos dentários e polpa e o tratamento das lesões em tecidos de sustentação na dentição decídua em situações de tratamento imediato e tardio.

The treatment of children presenting dental trauma in the primary dentition requires a different approach from that used in the permanent dentition, because there is a very close relation between the apex of the traumatized primary tooth and the successor permanent bud. The possible consequences on the permanent teeth should be considered when performing early treatment in order to prevent further damage. Also, the probable trauma?s late sequelae should be taken into account both for primary and permanent dentition. Given the subject?s importance, this chapter aimed to report this issue broadly. This comprises the anamnesis, general, intraoral, and radiographic examination and the comprehensive treatment of the patient. Additionally to the classification of dental injuries, we highlighted the diagnosis, required treatment, prognosis, and follow-up of each clinical situation. A topic on soft tissue lesion was included, because it has a great impact on both the child and family. Moreover, it could be associated with other trauma types. Since the analysis of the child?s vaccination status is suggested, in face of cases demanding that tetanus vaccine be valid, the recommendation of the Brazilian Ministry of Health was also informed. Furthermore, there is an item on dental splinting, parenting advice, and trauma consequences on primary and successor permanent teeth. At the end of the chapter, two tables summarize the early and delayed treatment of trauma involving primary tooth?s enamel, dentin, pulp, and supportive tissues.

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OBJECTIVE: To provide information with the purpose of helping pediatricians to recognize the risk factors for the onset of severe early childhood caries, allowing for early intervention and thus avoiding this preventable disease and its consequences. SOURCES: Information was collected from scientific articles published on the databases SciELO, MEDLINE and PUBMED in last 25 years, as well as technical books and guidelines of international committees. The keywords used were: early childhood caries, severe early childhood caries, dental caries, and children. SUMMARY OF THE FINDINGS: Severe early childhood caries affects infants and children. It is infectious, has a multifactor etiology and fast development, starting soon after dental eruption. Due to the presence of local sociocultural risk factors, it must be regarded as a symptom of alteration in the child's health and lack of adequate care. Its manifestations include pain, abscesses and chewing difficulty, affecting the child's feeding and sleep. Furthermore, it also affects the child's general health, speech, and self-esteem. CONCLUSIONS: Preventive methods to avoid severe early childhood caries have been developed and they should be used as early as possible by means of prevention programs carried out in the community and with families. Professionals responsible for providing care to babies and children should be aware of cases at risk for caries and interfere in order to improve their patients' health.

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OBJETIVO: Fornecer informações para auxiliar o médico pediatra a reconhecer os fatores de risco para o início da cárie precoce na infância e da cárie severa na infância (CSI), possibilitando a intervenção precoce de tais fatores, e, assim, evitar a instalação dessa doença prevenível e as suas consequências. FONTES DOS DADOS: As informações foram coletadas a partir de artigos científicos publicados nas bases de dados SciELO, MEDLINE e PUBMED nos últimos 25 anos, livros técnicos e publicações de consenso de organismos internacionais. As palavras-chave utilizadas foram: early childhood caries, severe early childhood caries, dental caries e children. SÍNTESE DOS DADOS: A CSI é uma forma de cárie dentária que afeta bebês e crianças. É infecciosa, de etiologia multifatorial e de desenvolvimento rápido, iniciando logo após a erupção dos dentes. Por apresentar fatores de risco local e sociocultural, deve ser considerada como sintoma de uma alteração na criança e de falta de cuidados adequados. Suas manifestações incluem dor, abscessos e dificuldades mastigatórias, afetando a alimentação e o sono da criança. Além disso, afeta também sua saúde geral, fala e autoestima. CONCLUSÕES: A CSI é uma doença com métodos preventivos estabelecidos, que devem ser introduzidos o mais precocemente possível, por meio de programas preventivos na comunidade e no núcleo familiar. Os profissionais que atendem bebês e crianças devem estar atentos aos casos com risco para o desenvolvimento da doença cárie e interceder a fim de se obter saúde.

OBJECTIVE: To provide information with the purpose of helping pediatricians to recognize the risk factors for the onset of severe early childhood caries, allowing for early intervention and thus avoiding this preventable disease and its consequences. SOURCES: Information was collected from scientific articles published on the databases SciELO, MEDLINE and PUBMED in last 25 years, as well as technical books and guidelines of international committees. The keywords used were: early childhood caries, severe early childhood caries, dental caries, and children. SUMMARY OF THE FINDINGS: Severe early childhood caries affects infants and children. It is infectious, has a multifactor etiology and fast development, starting soon after dental eruption. Due to the presence of local sociocultural risk factors, it must be regarded as a symptom of alteration in the child's health and lack of adequate care. Its manifestations include pain, abscesses and chewing difficulty, affecting the child's feeding and sleep. Furthermore, it also affects the child's general health, speech, and self-esteem. CONCLUSIONS: Preventive methods to avoid severe early childhood caries have been developed and they should be used as early as possible by means of prevention programs carried out in the community and with families. Professionals responsible for providing care to babies and children should be aware of cases at risk for caries and interfere in order to improve their patients' health.

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PURPOSE: The purpose of this study was to identify dental caries protection factors in 5-year-old children in the city of Curitiba, Brazil. METHODS: This case-controlled study was based on secondary data obtained from electronic medical records of 5-year-old children using Curitiba's municipal health service in 2005. Independent variables included those related to the child and his or her family context. The association between variables was studied by chi-squared, Fisher's exact, and Mann-Whitney's tests and multiple logistic regression. RESULTS: Caries experience was slightly associated with nutritional state, preschool experience (if the child regularly attended a preschool), and mother's age and education level. Multiple logistic regression confirmed most bivariate associations. Children who had normal weight (odds ratio [OR]=2.23; 95% confidence interval [CI]=1.04, 4.80) or who were overweight (OR=2.74; 95% CI=1.15, 6.53), did not go to preschool (OR=1.59; 95% CI=1.05, 2.41), and whose mothers were at least 26 years old (OR=1.62; 95% CI=1.14, 2.30) had a greater probability of being caries-free. CONCLUSION: Normal or overweight children who did not attend preschool and whose mothers were at least 26 years old had a greater probability of being caries-free.

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