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Previous issue date: 2008-04-18 === The aims of this study were to analyze the access of dental services by child population, to determine the prevalence of dental caries, gingivitis and malocclusion in resident children from the municipal district of Sobral Cear? and to evaluate the incidence of the dental decay in adolescents associated with the factors related to socioeconomic condition, access to health services and self-perception. This study had as main factor the multidisciplinary represented by the participation of health professional (doctors, dentists, nurses) in the development of the survey's initial reference; student from Human Sciences area to apply the structured questionnaire in domiciliary visits; statistics professionals in the orientation of the analysis to be held and family health team (community health agents, dentists and dental clinic assistants) in the scheduling of domiciliary visits and the accomplishment of oral exam. The sample was determined from the domicile record that included children born between 1990 and 1994 to develop the research Children health conditions in the municipal district of Sobral Cear? . The first sample comprised 3425 parents of children from 5 to 9 years old, living in the urban area at the municipal district of Sobral Cear?, aiming at identifying the most important factors associated to the access to dental service. From this sample, 1021 children were selected in a systematic way, for the accomplishment to the epidemiological study of decay, gingivitis and malocclusion. In the study's third phase, in order to arrange the group to be followed, 688 adolescents were examined and interviewed, by means of the active search from the 1021 individuals that had been previously examined. It was observed that 50.9% of the children had access to dental service at least once in a lifetime. Of this total, 65.3% accomplished it during the last year, and 85.4% of these did in public services, what allows to identify the importance of this sector in the access to dental services. It was observed that the factors that most affected the access to dental 129 services were related to socioeconomic condition, such as the access to health plan, the possession of toothbrush, garbage collecting, mother s schooling, sewerage treatment and malnutrition. In relation to oral diseases, an increase in the DMF-T index according the age was observed, from 0.10 in five years old to 1.66 in the nine years old, while with the dmf-t index, the inverse happened, since the index decreased from 3.59 in five years old to 2.69 in nine years old. In relation to gingivitis, an average 32.7% of the children presented gum bleeding. In what concerns malocclusion, it was observed that 60.3% of the children didn't present any problem, 30.17% had light malocclusion and 9.5% severe malocclusion. The average incidence of dental caries was 1.86 teeth per youngster. Among the studied variables, tooth pain in the last six months, mother's income and school snack, adjusted by the perception about the need of treatment, the mother's schooling and the dentist's appointment at least once in a lifetime, were the variables that presented positive relationship with the high incidence of dental caries on this population by logistic regression. Variables of socioeconomic nature, related to the access to health services and behavior and biological variables presented a relationship with the high caries incidence. The study point out to the need of developing health actions in a humanized way, by an oral health team effectively bound to the population's interest, with the great objective to provide, with the public health services managers, adequate conditions to improve oral health === Os objetivos do presente trabalho foram analisar o acesso da popula??o infantil ao servi?o odontol?gico, identificar a preval?ncia de c?rie, gengivite e maloclus?o em crian?as residentes no munic?pio de Sobral Cear? e avaliar a incid?ncia da c?rie dent?ria em adolescentes, associando-a a fatores relativos ? condi??o s?cio-econ?mica, acesso ? servi?os de sa?de e estilo de vida. O presente estudo teve como fator preponderante a multidisciplinaridade representada pela participa??o de profissionais de sa?de (m?dicos, cirurgi?es-dentistas, enfermeiros) na constru??o do referencial inicial da pesquisa, estudantes de cursos da ?rea de Ci?ncias Humanas, na aplica??o do question?rio estruturado para entrevista domiciliar; estat?sticos na orienta??o das an?lises a serem realizadas e equipe de sa?de da fam?lia (agentes comunit?rios de sa?de, cirurgi?es-dentistas e auxiliares de consult?rio dent?rio) no agendamento e realiza??o dos exames bucais domiciliares. A amostra foi definida a partir do cadastro de domic?lios que inclu?a crian?as nascidas entre 1990 e 1994 para desenvolvimento da pesquisa Condi??es de sa?de das crian?as no munic?pio de Sobral Cear? . A primeira amostra foi composta por 3425 pais de crian?as entre 5 e 9 anos de idade residentes no munic?pio de Sobral Cear?, visando identificar os principais fatores relacionados ao acesso a servi?o odontol?gico. A partir desta amostra, foram selecionadas 1021 crian?as, de forma sistem?tica, para realiza??o do levantamento epidemiol?gico de c?rie, gengivite e maloclus?o. Na terceira fase do estudo, visando ? composi??o da coorte a ser acompanhada, foram examinados e entrevistados 688 adolescentes, a partir da busca ativa dos 1021 indiv?duos que haviam sido preliminarmente examinados. Observou-se que 50,9% das crian?as tiveram acesso ao tratamento odontol?gico pelo menos uma vez na vida. Deste total, 65,3% o realizaram no decorrer do ?ltimo ano pesquisado, sendo que 85,4% destes na rede p?blica, o que permite identificar a import?ncia deste segmento no acesso aos servi?os odontol?gicos. Observou-se que os fatores que mais afetaram o acesso ao servi?o odontol?gico foram os vinculados ? condi??o s?cio-econ?mica como acesso ? plano de sa?de, posse de escova dent?ria, coleta de lixo, escolaridade da m?e, tratamento do esgoto e desnutri??o. Em rela??o ?s doen?as bucais observou-se um aumento do CPO-D com a idade, de 0,10 aos cinco anos para alcan?ar 1,66 aos nove anos de idade, ocorrendo o inverso em rela??o ao ?ndice ceo-d, uma vez que aos cinco anos o ?ndice de 3,59 decai para 2,69 aos nove anos. Quanto ?s altera??es gengivais, em m?dia, 32,7% das crian?as apresentavam sangramento gengival. Quanto ? maloclus?o, observou-se que 60,33% das crian?as n?o apresentavam problema, 30,17% apresentavam problemas leves e 9,5% problemas severos de maloclus?o. A incid?ncia m?dia de c?rie foi de 1,86 dentes por adolescente. Entre as vari?veis estudadas, dor de dente nos ?ltimos seis meses, renda da m?e e merenda escolar, ajustadas pela percep??o sobre necessidade de tratamento, escolaridade da m?e e consulta ao dentista pelo menos uma vez na vida, foram as vari?veis que apresentaram rela??o positiva com a alta incid?ncia de c?rie dent?ria desta popula??o, a partir da regress?o log?stica. Vari?veis de natureza s?cio-econ?mica, relativas ao acesso aos servi?os de sa?de, comportamentais e biol?gicas apresentaram rela??o com a alta incid?ncia de c?rie. O estudo aponta para a necessidade de implanta??o de servi?os odontol?gicos vinculados ao desenvolvimento de a??es de sa?de de forma humanizada, desenvolvidas por equipes de sa?de bucal efetivamente vinculadas aos interesses da popula??o, que tenham como grande objetivo proporcionar, junto com os gestores dos servi?os p?blicos de sa?de, condi??es adequadas para melhoria da sa?de bucal
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