Estudo dos protocolos de atenção à saúde da gestante de alto risco e prevalência de cárie dentária
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Data
2019-02-27
Autores
Custódio, Lia Borges de Mattos [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A gestação é um fenômeno fisiológico e deve ser considerada uma experiência de vida saudável, que envolve alterações físicas, sociais e emocionais, no entanto, alguns fatores de risco podem desencadear evolução desfavorável à gestação. O objetivo neste trabalho foi analisar protocolos de atenção à saúde bucal de gestantes e condições bucais relacionadas à cárie. Trata-se de um estudo transversal, descritivo, de análise documental e levantamento epidemiológico de saúde bucal, com gestantes de alto-risco de 28 municípios que fazem referência a um Ambulatório Médico de Especialidades do estado de São Paulo. Foram obtidos protocolos de cuidado à saúde das gestantes dos municípios pesquisados e verificados os dados sobre acesso, indicação da primeira consulta odontológica e critérios de referência e contrarreferência. No levantamento epidemiológico, 1500 gestantes foram examinadas; o índice CPOD foi calculado e as seguintes variáveis independentes foram verificadas: idade, renda, escolaridade, hipertensão arterial, hipertensão arterial gestacional, diabetes mellitus, diabetes mellitus gestacional, obesidade, tabagismo. Foram realizados testes estatísticos de qui-quadrado e análises univariada e multivariada ao nível de significância de 5%. Dentre os municípios, 53,57% (n=15) não possuíam nenhum documento instituído e 46,43% (n=13) apresentaram algum documento que contemplasse a atenção pré-natal médico/enfermeira e odontológico. Nos documentos encontrados (n=16), havia registros de cuidados gerais na gestação e apenas 4 apresentaram protocolo de atenção à saúde bucal. A forma de “acesso” mais frequente, descrita nos documentos, foi a livre demanda e não se observou a definição de “gestante” como grupo prioritário na descrição dos serviços. Os mecanismos de referência e contrarreferência e a indicação de ao menos uma consulta odontológica na gestação não foram contemplados nos protocolos de saúde bucal. Do total de gestantes, apenas 5,93% (n=89) apresentaram CPOD=0. A cárie foi associada às variáveis: renda (OR=2,21; p<0,01); nível educacional (OR=2,20; p<0,001); hipertensão arterial (OR=1,50; p<0,01), tabagismo (OR=1,83; p<0,001) e obesidade (OR=1,80; p<0,01). Conclui-se que o cuidado odontológico no período pré-natal não se apresenta de forma organizada em protocolos de atenção à saúde. Os mecanismos de referência e contrarreferência precisam ser aprimorados. As gestantes de alto-risco apresentaram alta prevalência de cárie dentária e houve associação com renda, escolaridade, hipertensão arterial, tabagismo e obesidade.
Abstract: Gestation is a physiological phenomenon and should be considered as a healthy life experience involving physical, social and emotional changes. However, some risk factors may trigger unfavorable pregnancy outcomes. The aim of this study was to analyze protocols of oral health care on pregnant women and prevalence of dental caries. This was a cross-sectional, descriptive, documentary analysis and epidemiological survey of oral health, with high-risk pregnant women from 28 municipalities that make reference to a center of secondary level of attention. Pregnant women health care protocols were obtained on the municipalities and verified the data of access, indication of the first dental appointment and reference and counterreference criteria. In the epidemiological survey, 1500 pregnant women were examined; the DMFT index was calculated and the following independent variables were verified: age, income, educational level, arterial hypertension, gestational hypertension, diabetes mellitus, gestational diabetes mellitus, obesity, smoke. Statistical tests of chi-square and univariate and multivariate analyzes were performed at a significance level of 5%. Among the municipalities, 53.57% did not have any documents instituted and 46.43% presented some document that contemplated prenatal medical / nurse and dental care. In the documents found (n = 16), there were records of general care in gestation and only 4 presented oral health care protocol. The most frequent form of "access", described in the documents, was free demand and the definition of "pregnant" as a priority group in the services description was not observed. The system of reference and counter-referral and the indication of at least one dental appointment during pregnancy were few contemplated in the oral health protocols. Of the total number of pregnant women, only 5.93% (n = 89) had DMFT = 0. Dental caries were associated with: income (OR = 2.21, p <0.01); educational level (OR = 2.20, p <0.001); hypertension (OR = 1.50, p <0.01), smoke (OR = 1.83, p <0.001) and obesity (OR = 1.80, p <0.01). It was concluded that dental care in the prenatal period is not organized in health care protocols. The mechanisms of reference and counterreference need to be improved. High-risk pregnant women had a high prevalence of dental caries and there was an association with income, educational level, hypertension, smoking and obesity.
Abstract: Gestation is a physiological phenomenon and should be considered as a healthy life experience involving physical, social and emotional changes. However, some risk factors may trigger unfavorable pregnancy outcomes. The aim of this study was to analyze protocols of oral health care on pregnant women and prevalence of dental caries. This was a cross-sectional, descriptive, documentary analysis and epidemiological survey of oral health, with high-risk pregnant women from 28 municipalities that make reference to a center of secondary level of attention. Pregnant women health care protocols were obtained on the municipalities and verified the data of access, indication of the first dental appointment and reference and counterreference criteria. In the epidemiological survey, 1500 pregnant women were examined; the DMFT index was calculated and the following independent variables were verified: age, income, educational level, arterial hypertension, gestational hypertension, diabetes mellitus, gestational diabetes mellitus, obesity, smoke. Statistical tests of chi-square and univariate and multivariate analyzes were performed at a significance level of 5%. Among the municipalities, 53.57% did not have any documents instituted and 46.43% presented some document that contemplated prenatal medical / nurse and dental care. In the documents found (n = 16), there were records of general care in gestation and only 4 presented oral health care protocol. The most frequent form of "access", described in the documents, was free demand and the definition of "pregnant" as a priority group in the services description was not observed. The system of reference and counter-referral and the indication of at least one dental appointment during pregnancy were few contemplated in the oral health protocols. Of the total number of pregnant women, only 5.93% (n = 89) had DMFT = 0. Dental caries were associated with: income (OR = 2.21, p <0.01); educational level (OR = 2.20, p <0.001); hypertension (OR = 1.50, p <0.01), smoke (OR = 1.83, p <0.001) and obesity (OR = 1.80, p <0.01). It was concluded that dental care in the prenatal period is not organized in health care protocols. The mechanisms of reference and counterreference need to be improved. High-risk pregnant women had a high prevalence of dental caries and there was an association with income, educational level, hypertension, smoking and obesity.
Descrição
Palavras-chave
Atenção à saúde, Saúde bucal, Gestantes, Sistema de saúde, Cárie dentária, Dental caries, Gestation, Pregnant woman, Oral health, Chronic disease