Background Access to oral health services remains a challenge in the Brazilian healthcare system, especially in the primary health care setting, where the use of a risk stratification tool that could identify individuals with higher dental vulnerability would be extremely valuable. However, there literature on this theme is scarce, and there is no validated instrument in Brazil that is capable of measuring dental vulnerability. Hence, this psychometric study aimed at the development and evaluation of content and internal structure validity of the Dental Vulnerability Scale for Primary Health Care (PHC). Methods The items were developed based on a qualitative exploratory analysis. A total of 172 items were prepared and submitted to a panel of specialists, with content validity analyzed with the Content Validity Ratio (CVR), resulting in an the initial version of the instrument composed by 41 items. Internal structure validity was analyzed by Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and by applying 3 reliability indicators (Cronbach’s Alpha, McDonald's Omega and Greatest Lower Bound – GBL), with a sample of 1227 individuals. Results The final configuration indicated a scale of 15 items divided into 4 dimensions (overall health, oral health, infrastructure, and healthcare services) with explained variance of 72.11%. The factor loads varied from 0.37 to 0.96. The model adjustment indices were set at × 2/df(51) = 3.23, NNFI = 0.95, CFI = 0.98, GFI = 0.96, AGFI = 0.97, RMSEA = 0.04 and RMSR = 0.03. Conclusion DVS presented satisfactory evidence of validity, indicating its suitability to be used by healthcare professionals, students and managers to plan oral health actions and services at PHC.

The state of São Paulo, Brazil, where more than 94.000 dentists are currently registered, has become the epicenter of COVID-19 in Latin America. The aim of this cross-sectional study was to evaluate the impact of COVID-19 pandemic on dentists in this state. A semi-structured questionnaire was sent via e-mail to 93.280 dentists with active registration in the Dental Council of São Paulo (CROSP). The impact of COVID-19 pandemic was assessed through questions related to demographic, socioeconomic, dental practice characteristics and personal protective equipment (PPE) use. Ordinal logistic regression analysis was performed to investigate the association between all the variables (p<0.05). Over 8 days, 2113 responses were received. Only 26.52% of the sample reported a low-income reduction (from 0–10%), while the majority of dentists reported a more negative financial impact, 35.6% with a reduction of more than 50% of their monthly income. Dentists who worked in the private sector and at the capital had a greater financial impact when compared to those of the public sector and countryside of the state (p<0.05). Furthermore, about 83% reported not having received any specific training to control the transmission of coronavirus in the health area. This study provides evidence of the negative impact of the COVID-19 pandemic on the routine of dentists in the state of São Paulo, Brazil. Hopefully, this study will help dental and other health care professionals to better understand the consequences of disease in dental settings and strengthen preparedness throughout the dental health care system.

Objective: To evaluate the consumption of ultra-processed foods among children, and to investigate associations with socioeconomic and demographic factors. Methods: An analytical cross-sectional study with 599 children aged 6 months to 2 years, and listed as users of Family Health Units, in a medium-size city. Mothers were approached at home by researchers and community health workers from the Family Health Units, for data collection. Two questionnaires were used: the socioeconomic and demographic questionnaire, and the form Sistema de Vigilância Alimentar e Nutricional of Ministério da Saúde do Brasil , for children aged 6 months to 2 years. Ultra-processed food consumption and socioeconomic and demographic factors were defined as dependent and independent variables, respectively. Multiple regression analysis with a significance level of 5% was used to test associations between ultra-processed food consumption and socioeconomic and demographic variables. Results: Ultra-processed food consumption was associated with child age between 1 and 2 years (OR=3.89; 95%CI: 2.32-6.50 and OR=3.33; 95%CI: 2.00-5.56, respectively), number of people living in the same household (OR=1.94; 95%CI: 1.23-3.05), and recipients of government benefits (OR=1.88; 95%CI: 1.15-3.04). Conclusion: Ultra-processed food consumption among children undergoing complementary feeding may be influenced by socioeconomic and demographic factors.

Objective: To present a concept of dental vulnerability based on the opinion of oral health professionals in Brazil. Methods: A cross-sectional study performed in two stages: preparation of a questionnaire by literature search and its application with oral health specialists. The data were analyzed by means of Bardin technique and descriptive analysis. Results: A total of 188 professionals from all regions of Brazil responded to the questionnaire. The answers were classified into seven dimensions, conceptualizing dental vulnerability as a set of social, structural, overall health, mental, and oral health factors, in addition to factors involving the health services and public management that influence the health-disease process dynamic. Conclusion: The concept of dental vulnerability produced from the opinions of the professionals from different regions of Brazil allows advancement to new studies on the theme and the development of instruments aiming to measure the phenomenon.

Background Offering equitable access to dental care remains a challenge and methods to risk-stratify individuals to prioritize care could help to attain that goal. The interaction of multiple risk factors associated with oral disease vulnerability can outweigh protective factors conferring resilience and resistance to individuals and their communities; however, there is no validated instrument for measuring oral disease vulnerability. Hence, the objective of this study was to develop a Dental Vulnerability Scale (EVO) for primary health care (PHC) and evaluate its content validity and internal structure. Methods This was a psychometric study conducted in São Paulo, Brazil, in 2019. During content validation, 172 items were evaluated by a panel of 40 judges with diverse background and with the application of the Content Validity Ratio (CVR), considering a critical CVR value&gt; 0.26. During the internal structure evaluation, the EVO was applied to a sample of 1227 individuals in the PHC setting and the results were analyzed using Exploratory and Confirmatory Factor Analysis, in addition to the application of 3 reliability indicators (Cronbach's alpha, McDonald's Omega and Greatest Lower Bound). Results The CVR was 0.33 for relevance and 0.39 for clarity, resulting in 41 items. The final EVO was composed of 4 dimensions (general health, oral health, infrastructure and health services) with a total of 15 items. Factor loadings ranged from 0.37 to 0.96, with R-squared values ranging from 0.14 to 0.91. The reliability indicators values were α = 0.64, ω = 0.99 and GLB=0.82. The Goodness of fit were NNFI = 0,95, CFI = 0,98, GFI = 0,96 and AGFI = 0,97. The EVO instrument was considered valid to be used among oral health professionals in the PHC setting. Conclusions The EVO showed satisfactory psychometric properties and could be employed by health professionals and managers to plan actions and*inform* policies related to oral health. Key messages The EVO could be used to risk-stratify individuals in the PHC setting. The EVO could help to inform oral health policies.