Aspectos epidemiológicos da utilização de medicamentos em odontologia

Abstract

This dissertation encompassed three studies, reported in five scientific manuscripts, that addressed the subject of medication use in Dentistry. The first study consisted of a systematic review, the second a cross-sectional study, and the third involved time-series analyses. The systematic review (PROSPERO: CRD42020211226), aimed to investigate the relationship between sociodemographic factors and opioid prescriptions. Searches were conducted in eight electronic databases: MEDLINE (PubMed), Embase, Scopus, Web of Science, LILACS, SciELO, Google Scholar, and Open Grey. Two researchers independently selected the studies (Cohen Kappa=0.80), extracted the data, and assessed the risk of bias. The results were presented in a narrative synthesis. The second study, a cross-sectional secondary data study, analyzed the potential drug-drug interactions involving psychotropic drugs prescribed by dental practitioners in Minas Gerais (MG) in 2017. Data from the Integrated Pharmaceutical Care Management System (Sigaf) were used; this system provided information about all medication dispensed by public health services, which enabled the identification of individuals on concomitant use of at least two drugs. Drugs were grouped according to the Anatomical Therapeutic Chemical Classification System, and the number of Defined Daily Doses (DDD) was calculated. Individuals, regardless of age, on concomitant use of psychotropics and other drugs were included. Afterwards, potential drug-drug interactions were screened using the IBM Micromedex® Drug Interactions database. The third study, a time-series analysis, aimed to describe trends of dentist-prescribed antibacterials, nonsteroidal anti-inflammatory drugs (NSAID), and analgesics from 2011 to 2021 in MG, as well as to examine possible associations with characteristics of oral health services. The number of DDD and DDD/1,000 inhabitants/year (outcome) was estimated for each municipality in MG. Covariates referred to characteristics of the health services, such as coverage of oral health care, estimates of dental procedures, and frequency of toothache. For the outcome variable, a logarithmic transformation was performed, and simple and multiple linear time-series regression models were used in the analysis. The findings of the systematic review showed, with very low certainty of evidence, that younger individuals were more likely to receive a prescription of opioids than older individuals. In the cross-sectional study, the prevalence of potential drug-drug interactions was 24.8%, accounting for 648 cases, with the majority (n=438; 67.6%) being of major severity. The time-series analysis showed an overall increase in dental prescriptions during the period under investigation. The log of the number of DDD/1,000 inhabitants increased by an average of 0.35 (p<0.001) per year for antibacterials, 0.38 (p<0.001) for NSAID, and 0.28 for analgesics between 2011 and 2021.Regression models indicated that only the frequency of toothache was associated with NSAID use. These results emphasized important aspects of medications prescribed by dental practitioners, underlining the need for strategies to ensure patient safety.