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To describe trends of dentist-prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics, from January 2011 to December 2021, as well as to examine the relationship between these trends and characteristics of public oral health services in Minas Gerais, Brazil. In this time-series analysis, all drugs were classified according to the Anatomical Therapeutic Chemical classification system. Drugs categorized as NSAIDs (M01A), and other analgesics and antipyretics (N02B) were included for analysis. The outcome was the number of Defined Daily Doses (DDDs)/1000 inhabitants/year for NSAIDs and analgesics in each town. Covariates referred to characteristics of public oral health services, such as coverage, estimates of dental procedures, and frequency of toothache. Linear time-series regression models were used to determine the influence of covariates on the outcome. Overall, there were 58,482 prescriptions of NSAIDs recorded in thirty-eight towns, while 47,499 prescriptions of analgesics in forty-three towns. For each year, there was a 0.38 (p < 0.001), and 0.28 (p < 0.001) increase in the average log of DDD/1000 inhabitants/year for NSAIDs and analgesics, respectively. A positive association was detected between toothache (p < 0.001) and the prescription of NSAIDs. Over the eleven years, there was a general rising trend in the prescriptions. Toothache was the only characteristic of public oral health services associated with the prescription rates of NSAIDs, implying that as the frequency of toothaches increase, so do the prescriptions of NSAIDs in the studied towns.

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OBJECTIVE: To determine the prevalence of potential drug-drug interactions involving psychotropics prescribed by dentists, and dispensed by the public healthcare system, as well as to describe the severity and level of evidence of those interactions in the state of Minas Gerais, Brazil. MATERIALS AND METHODS: We conducted data analysis from pharmaceutical claims in which dental patients received systemic psychotropics in 2017. Data from the Pharmaceutical Management System provided the drug dispensing history of the patients, allowing the identification of those on concomitant medication use. The outcome was the occurrence of potential drug-drug interactions, which were detected according to IBM Micromedex®. Independent variables were the patient's sex, age, and the number of drugs used. Descriptive statistics was performed using SPSS v. 26. RESULTS: Overall, 1480 individuals were prescribed psychotropic drugs. The prevalence of potential drug-drug interactions was 24.8% (n = 366). The total of 648 interactions was observed and, most of which were of major severity (n = 438, 67.6%). Most interactions occurred in female individuals (n = 235; 64.2%), with 46.0 (±17.3) years-old, concurrently taking 3.7 (±1.9) drugs. CONCLUSION: A substantial proportion of dental patients presented potential drug-drug interactions, mostly of major severity, which might be life-threatening.

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Abstract This article aims to investigate the association between socioeconomic factors, health care organizations, and the use of a management and monitoring system for the dispensing of antibiotics prescribed by dentists in public health services in Minas Gerais, Brazil. This is an ecological-epidemiological study that analyzed secondary data from the Integrated Pharmaceutical Care Management System (SIGAF) of the Department of Health of the state of MG, Brazil, in 2017. Thirteen independent variables were analyzed to assess their influence on municipal adherence to SIGAF system considering dental prescriptions of antibiotics. Descriptive statistical analyses were performed, and the Classification and Regression Tree technique was used to identify the municipal variables associated with the outcome. A total of 57,279 antibiotic courses prescribed by dentists and recorded in SIGAF were examined. Socioeconomic factors were not associated with the use of SIGAF to record these prescriptions. Oral healthcare coverage was positively associated with the use of SIGAF for the dispensing of antibiotics prescribed by dentists. Dental Specialties Center were negatively associated with the outcome. Municipalities with high oral healthcare coverage and those without a Dental Specialties Center were more likely to use SIGAF.

Resumo O objetivo deste artigo é avaliar a associação entre fatores socioeconômicos, organização dos serviços de saúde e a utilização de um sistema de gestão e monitoramento da dispensação de antibióticos prescritos por cirurgiões-dentistas em Minas Gerais, Brasil. Estudo epidemiológico ecológico que analisou dados secundários do Sistema Integrado de Gestão da Assistência Farmacêutica (SIGAF) da Secretaria de Estado de Saúde de MG, Brasil, em 2017. Treze variáveis independentes foram analisadas para testar a influência destas com a adesão dos municípios ao SIGAF das prescrições odontológicas de antibióticos. Foram realizadas análises estatísticas descritivas, e a técnica de Árvore de Classificação e Regressão foi utilizada. Foram examinadas 57.279 prescrições de antibióticos prescritos por dentistas e registradas no SIGAF. Fatores socioeconômicos não foram associados ao uso do SIGAF para registro dessas prescrições. A cobertura de saúde bucal esteve positivamente associada à utilização do SIGAF para as dispensações de antibióticos prescritos por cirurgiões-dentistas. A presença de Centro De Especialidade Odontológica, esteve negativamente associado ao desfecho. Municípios com maior cobertura de saúde bucal e sem Centro de Especialidade Odontológica foram mais propensos a utilizar o SIGAF.

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This article aims to investigate the association between socioeconomic factors, health care organizations, and the use of a management and monitoring system for the dispensing of antibiotics prescribed by dentists in public health services in Minas Gerais, Brazil. This is an ecological-epidemiological study that analyzed secondary data from the Integrated Pharmaceutical Care Management System (SIGAF) of the Department of Health of the state of MG, Brazil, in 2017. Thirteen independent variables were analyzed to assess their influence on municipal adherence to SIGAF system considering dental prescriptions of antibiotics. Descriptive statistical analyses were performed, and the Classification and Regression Tree technique was used to identify the municipal variables associated with the outcome. A total of 57,279 antibiotic courses prescribed by dentists and recorded in SIGAF were examined. Socioeconomic factors were not associated with the use of SIGAF to record these prescriptions. Oral healthcare coverage was positively associated with the use of SIGAF for the dispensing of antibiotics prescribed by dentists. Dental Specialties Center were negatively associated with the outcome. Municipalities with high oral healthcare coverage and those without a Dental Specialties Center were more likely to use SIGAF.

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The objective of this study was to analyze possible associations between antibiotic dental prescriptions in the public health service, health service characteristics, and social characteristics of the municipalities. Using the register of dispensing in the public health service of a state in the Southeast region of Brazil, in 2017 we analyzed patterns of antibiotic prescriptions by dentists. Data were obtained from the Integrated Pharmaceutical Services Management System (SIGAF, in Portuguese). The outcome variable was the number of Daily Defined Doses (DDD) per 1,000 residents/year in each municipality. CART (Classification and Regression Tree) technique was used to determine the influence of the following variables: populational social characteristics (Human Development Index, Gini Index, the proportion of rural population and proportion of families benefiting from the Bolsa Família Program) and oral health services characteristics (access to individual dental care, number of dentists and oral health teams per 1,000 residents, and percentage of preventive and restorative individual dental procedures. Data analysis was performed using IBM SPSS Statistics 21.0. Antibiotics were the medications most prescribed by dentists in the public health service, with penicillin being the most frequently prescribed class. The average DDD/1,000 residents/year for the 421 municipalities surveyed was 96.54 (range 0.008 and 619.660). Select factors were associated with antibiotic prescriptions including access to individual dental care (Adjusted p-value ≤0.001), a number of oral health teams/1,000 inhabitants (Adjusted p-value=0.001), and Gini Index (Adjusted p-value = 0.046). Access to oral health services and inequality were associated with the use of antibiotics.

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Abstract The objective of this study was to analyze possible associations between antibiotic dental prescriptions in the public health service, health service characteristics, and social characteristics of the municipalities. Using the register of dispensing in the public health service of a state in the Southeast region of Brazil, in 2017 we analyzed patterns of antibiotic prescriptions by dentists. Data were obtained from the Integrated Pharmaceutical Services Management System (SIGAF, in Portuguese). The outcome variable was the number of Daily Defined Doses (DDD) per 1,000 residents/year in each municipality. CART (Classification and Regression Tree) technique was used to determine the influence of the following variables: populational social characteristics (Human Development Index, Gini Index, the proportion of rural population and proportion of families benefiting from the Bolsa Família Program) and oral health services characteristics (access to individual dental care, number of dentists and oral health teams per 1,000 residents, and percentage of preventive and restorative individual dental procedures. Data analysis was performed using IBM SPSS Statistics 21.0. Antibiotics were the medications most prescribed by dentists in the public health service, with penicillin being the most frequently prescribed class. The average DDD/1,000 residents/year for the 421 municipalities surveyed was 96.54 (range 0.008 and 619.660). Select factors were associated with antibiotic prescriptions including access to individual dental care (Adjusted p-value ≤0.001), a number of oral health teams/1,000 inhabitants (Adjusted p-value=0.001), and Gini Index (Adjusted p-value = 0.046). Access to oral health services and inequality were associated with the use of antibiotics.

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Abstract The objective of this study was to describe dental prescriptions of non-steroidal anti-inflammatory drugs (NSAID), opioids, and analgesics dispensed by the Brazilian National Health System (BNHS, SUS in Portuguese) of a Southeastern state from January to December 2017, and to analyze their association with socioeconomic and oral health care services' characteristics at municipal level. Data were collected from the Brazilian Integrated Pharmaceutical Care Management System. Medicines were grouped according to the Anatomical Therapeutic Chemical Classification System. The total number of Defined Daily Doses (DDD) and DDD per 1,000 inhabitants (inhab.) per year were presented and compared between groups of municipalities. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25.0. The total number of NSAID, opioids, and analgesics prescriptions was 70,747 and accounted for 354,221.13 DDD. The most frequently prescribed medicine was ibuprofen (n = 24,676; 34.88%). The number of dental practitioners in the BNHS per 1,000 inhab. (p < 0.001), first dental appointment coverage (p = 0.010), oral health teams per 1,000 inhab. (p=0.022), and the proportion of rural population (p = 0.014) were variables positively associated with the number of DDD of NSAID per 1,000 inhab. per year. Bolsa Família program coverage per 1,000 inhab. (p = 0.022) was negatively associated with NSAID prescription. Regarding analgesics, first dental appointment coverage (p=0.002) and Bolsa Família program coverage per 1,000 inhab. (p = 0.012) were positively associated with DDD per 1,000 inhab. per year. In conclusion, dental prescriptions of analgesics and NSAID in the BNHS were associated with socioeconomic and oral health care services' characteristics.

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Antibióticos, juntamente com analgésicos e anti-inflamatórios, são os medicamentos mais utilizados em odontologia. A prescrição de antibióticos por cirurgiões-dentistas acontece em todo o mundo, sendo que o uso adequado desses medicamentos pode resultar em falha terapêutica, aumento do risco de reações adversas e impacto econômico, além de ser a principal causa de resistência antimicrobiana. A literatura aponta que dor de origem dental raramente é causada por uma infecção bacteriana que requer medicação antibiótica e geralmente é melhor gerenciada com o uso de analgésicos e procedimentos odontológicos locais. Os resultados de pesquisas realizadas na Inglaterra e Canadá sugerem que as prescrições de antibióticos por cirurgiões-dentistas estão aumentando de forma alarmante. Sabe-se também que o padrão de prescrição de antibióticos pode ser influenciado por fatores clínicos e não clínicos. Nesse sentido, gerar informação sobre o consumo de antibióticos é essencial para que os países adotem medidas para a conscientização da população e profissionais de saúde sobre o uso apropriado desses medicamentos, monitorem o impacto das intervenções e aprimorem o processo de aquisição, prescrição e dispensação desses medicamentos. O objetivo deste estudo foi analisar a possível associação entre prescrições odontológicas de antibióticos no setor público de um estado do sudeste brasileiro, características dos serviços de saúde e características sociais municipais. O desenho do estudo foi do tipo ecológico, o ano analisado foi o de 2017 e os dados foram obtidos do banco de dados do Sistema Integrado de Gerenciamento da Assistência Farmacêutica. A variável desfecho do primeiro artigo dessa Tese de Doutorado foi o número de Doses Diárias Definidas (DDD) por 1.000 habitantes/ano dos municípios. A variável desfecho do segundo artigo foi a adesão dos municípios a um sistema de informação de prescrições odontológicas. O banco de dados foi analisado inicialmente no programa Excel versão 2016 (Microsoft, Seattle, USA) e posteriormente no programa SPSS versão 25.0 (IBM SPSS Statistics for Windows, Armonk, NY, USA). A técnica CART (Classification And Regression Tree) foi usada para determinar a influência das características sociais dos municípios (Índice de Desenvolvimento Humano, Índice Gini, proporção de população rural, proporção de famílias beneficiárias do Programa Bolsa Família, tipologia rural/urbana, ser ou não município sede de Centro de Especialidades Odontológicas, sede de Macrorregião e Microrregião de Saúde) e das características dos serviços de saúde bucal (cobertura de saúde bucal na Estratégia Saúde da Família e na Atenção Primária à Saúde, cobertura populacional de primeira consulta odontológica, número de cirurgiões-dentistas e de equipes de saúde bucal por 1000 habitantes e percentual de procedimentos odontológicos individuais preventivos e restauradores). Os antibióticos foram os medicamentos mais prescritos pelos cirurgiões-dentistas do setor público pesquisado, sendo as penicilinas o grupo mais prescrito. A média geral de DDD/1000hab/ano, para os 421 municípios pesquisados, foi de 96,54. Fatores de organização de serviços estiveram associados à aceitabilidade dos municípios ao sistema de vigilância analisado.Concluiu-se que fatores socioeconômicos e de organização dos serviços de saúde estiveram associados à utilização de antibióticos. Há necessidade de avanços na vigilância da prescrição de antibióticos nos serviços públicos de saúde bucal do estado de Minas Gerais.

Antibiotics, along with analgesics and anti-inflammatory drugs, are the most commonly used medications in dentistry. The prescription of antibiotics by dental surgeons happens all over the world, and the irrational use of these drugs can result in therapeutic failure, increased risk of adverse reactions and economic impact, besides being the main cause of antimicrobial resistance. The literature points out that pain of dental origin is rarely caused by a bacterial infection requiring antibiotic medication and is usually best managed with the use of analgesics and local dental procedures. The results of surveys conducted in England and Canada suggest that antibiotic prescriptions by dental surgeons are increasing alarmingly. It is also known that the pattern of antibiotic prescribing can be influenced by both clinical and nonclinical factors. In this sense, generating information on antibiotic consumption is essential for countries to adopt measures to raise awareness among the population and health professionals about the appropriate use of these drugs, monitor the impact of interventions, and improve the process of acquiring, prescribing, and dispensing these drugs. The aim of this study was to analyze the possible association between dental antibiotic prescriptions in the public sector of a southeastern Brazilian state, health services characteristics, and municipal social characteristics. The study design was of the ecological type, the year analyzed was 2017, and the data were obtained from the database of the Integrated Pharmaceutical Assistance Management System. The outcome variable of the first article of this PhD Thesis was the number of Defined Daily Doses (DDD) per 1,000 inhabitants/year of the municipalities. The outcome variable of the second article was the municipalities' adherence to a dental prescription information system. The database was analyzed initially in Excel version 2016 program (Microsoft, Seattle, USA) and later in SPSS version 25.0 program (IBM SPSS Statistics for Windows, Armonk, NY, USA). The CART (Classification And Regression Tree) technique was used to determine the influence of the social characteristics of the municipalities (Human Development Index, Gini Index, proportion of rural population, proportion of beneficiary families of the Bolsa Família Program, rural/urban typology, whether or not the municipality is the headquarters of a Dental Specialties Center, seat of a Health Macro-region and Microregion) and the characteristics of oral health services (oral health coverage in the Family Health Strategy and Primary Health Care, population coverage of first dental consultation, number of dentists and oral health teams per 1000 inhabitants, and percentage of individual preventive and restorative dental procedures). Antibiotics were the most prescribed drugs by dental surgeons in the public sector surveyed, with penicillins being the most prescribed group. The overall average of DDD/1000hab/year, for the 421 municipalities surveyed, was 96.54. It was concluded that socioeconomic factors and organization of health services were associated with the use of antibiotics. There is a need for advances in the surveillance of antibiotic prescribing in public oral health services in the state of Minas Gerais.

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The objective of this study was to describe dental prescriptions of non-steroidal anti-inflammatory drugs (NSAID), opioids, and analgesics dispensed by the Brazilian National Health System (BNHS, SUS in Portuguese) of a Southeastern state from January to December 2017, and to analyze their association with socioeconomic and oral health care services' characteristics at municipal level. Data were collected from the Brazilian Integrated Pharmaceutical Care Management System. Medicines were grouped according to the Anatomical Therapeutic Chemical Classification System. The total number of Defined Daily Doses (DDD) and DDD per 1,000 inhabitants (inhab.) per year were presented and compared between groups of municipalities. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25.0. The total number of NSAID, opioids, and analgesics prescriptions was 70,747 and accounted for 354,221.13 DDD. The most frequently prescribed medicine was ibuprofen (n = 24,676; 34.88%). The number of dental practitioners in the BNHS per 1,000 inhab. (p < 0.001), first dental appointment coverage (p = 0.010), oral health teams per 1,000 inhab. (p=0.022), and the proportion of rural population (p = 0.014) were variables positively associated with the number of DDD of NSAID per 1,000 inhab. per year. Bolsa Família program coverage per 1,000 inhab. (p = 0.022) was negatively associated with NSAID prescription. Regarding analgesics, first dental appointment coverage (p=0.002) and Bolsa Família program coverage per 1,000 inhab. (p = 0.012) were positively associated with DDD per 1,000 inhab. per year. In conclusion, dental prescriptions of analgesics and NSAID in the BNHS were associated with socioeconomic and oral health care services' characteristics.

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ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Dental caries in South American Indigenous people: A systematic review. Soares GH, Pereira NF, Gabriela M, Biazevic H, Braga MM, Michel-Crosato E. Community Dent Oral Epidemiol 2019;47(2):142-52. SOURCE OF FUNDING: Brazilian National Council for Scientific and Technological Development (CNPq). TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

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